1NC

Economy DA
The US economy will grow in 2023 – job market strength, 2% growth, and falling
inflation prove.
Jennifer Sor 9/12 ( a junior reporter for Markets Insider. She graduated from UC Santa Barbara with a BA
in Economics and English; 9/12/23; “The US economy is riddled with green flags and is headed for an
expansion, not a recession, according to Fundstrat's Tom Lee”; https://ca.finance.yahoo.com/news/us-
economy-riddled-green-flags-222406842.html)
The US economy has too many green flags to slip into a recession, according to Fundstrat's Tom Lee.
Lee suggested the economy would actually enter an expansion in 2023.
He pointed to five positive economic indicators that suggest a better market is on the horizon.
The US economy is actually showing signs of entering an expansion, not a recession, according to
Fundstrat's head of research Tom Lee.
Lee, who is one of the most bullish Wall Street commentators, pointed to a handful of positive indicators
in the economy that suggest inflation is coming under the Fed's control and the US may not slip into a
hard landing after all.
"I think that this year we essentially slip into an expansion," Lee said in a video sent to Fundstrat clients on Monday, pointing to five "green
shoots" that are currently sending bullish signals on the US economy:

1. The job market is still strong.

The labor force has boomed over the past few years, with the number of civilian workers growing at an
average pace of 1.9% a year since 2021, Lee said. That's up from the average 0.7% a year from 2010 to
2019.
Economists have said that the strong labor market has buoyed the US economy, despite the Fed's
aggressive monetary tightening over the last year. While gains have slowed, the US added another
187,000 jobs in August, up from the revised 157,000 new jobs added in July, according to the Bureau of
Labor Statistics.
2. Inflation expectations are dropping.
Consumer inflation expectations have plunged over the past few years – another positive indicator for the
economy. One-year forward inflation expectations slumped to 3.6% in September, according to the New York Fed, down from the 6.8%
recorded in June 2022.

Meanwhile, three-year forward inflation expectations dropped to 2.8% in September, down from 4.2% in October 2021. That's especially
significant, as it means Americans are expecting inflation to decline over the long-run.

3. Rent prices are falling.

Shelter prices are the largest contributor of inflation in the economy, and rent prices have plunged from
their 2021 peaks.
Apartment List's National Rent Index dropped to -1.2% in August, down from a nearly 20% increase in rent prices in late 2021. Meanwhile, the
percentage of US states with rent declines rose to 45% in August, up from 0% in July of last year.

Declining shelter inflation could easily help inflation drop like a rock, Lee previously suggested.
4. Yellen is feeling better about the US economy.
Treasury Secretary Janet Yellen has turned more optimistic on the economy, suggesting last week that
the US may be able to avoid a recession.
"The economy is fundamentally in good shape, and inflation is coming down if you measure it on a 12-
month basis," she said in a briefing on Friday, though she acknowledged that there was "still work to do"
to lower prices.
5. Stock market volatility has fallen.
The stock market's volatility gauge briefly slipped below 13 last week, nearing its lowest level since the
start of 2023. That's a sign investors are feeling more confident, as volatility generally picks up when the economy
flashes signs of weakness.

But investors have more economic data to digest, including the August inflation report on Wednesday, which will give guidance on whether the
economy needs additional monetary tightening. The annual pace of consumer inflation is expected to have to accelerated to 3.6% from the 3.2%
rate recorded in July.

An overwhelming majority of sources agree that Single-Payer would decimate the

economy. It requires massive tax spending that would shrink GDP 24%.
PAHCF 20 — Partnership for America’s Health Care Future, citing many different sources, 2020
(“Medicare For All Could ‘Decimate’ The Economy,” Partnership for America’s Health Care Future,
02-04-2020, Available Online at https://americashealthcarefuture.org/medicare-for-all-could-decimate-
the-economy/, Accessed on 05-20-2023)

WASHINGTON – The unaffordable costs , tax increases and negative economic consequences of
proposed one-size-fits-all new government health insurance systems – such as Medicare for All, Medicare
buy-in and the public option – continue to make headlines . A new analysis from Penn Wharton reveals
that Medicare for All could “could shrink U.S. GDP by as much as 24% by the year 2060,” Yahoo
Finance reports.

… [T]he model warns, if the plan is deficit-financed – paid for by government borrowing – “the negative
effects of larger deficits on labor supply , capital accumulation and GDP would significantly
outweigh the positive effects on the economy that come from a larger and healthier workforce.”

… According to studies, the cost of Medicare for all sits at roughly $32 trillion over the next decade.
But, as the analysis notes, [Senator Bernie] Sanders’ universal health care plan doesn’t have a built-in
financing mechanism … Sanders’ wealth tax would generate $1 trillion less in revenue than he stated …
The real trouble comes when Medicare for all is financed by deficits. With government borrowing,
universal health care could shrink the economy by as much as 24% by 2060, as investments in private
capital are reduced .
The one-size-fits-all government health insurance system “could decimate the economy ,” the
Washington Examiner adds.

This contributes to the mounting evidence that Medicare for All would burden American families with
unaffordable new costs , as the Urban Institute finds “that federal spending on health care would
increase by roughly $34 trillion under a single-payer plan similar to Medicare for All,” CNN reports. The
Committee for a Responsible Federal Budget (CRFB) finds that “fully offsetting the cost would require
higher taxes on the middle class” and would “require the equivalent of tripling payroll taxes or more
than doubling all other taxes .” Senator Sanders previously acknowledged that Americans making more
than $29,000 per year would “pay more in taxes” for Medicare for All.

“No matter how you cut the numbers, there is absolutely no way to pay for Medicare for all without tax
increases – or spending cuts – on the middle class,” Marc Goldwein of CRFB told POLITICO. “ There’s
no question it hits the middle class,” Kenneth Thorpe, Chairman of the Health Policy and Management
Department, Emory University told The Washington Post.
“Although [Medicare for All’s supporters] have frequently stressed that the middle class would see
overall costs go down, a wide range of experts … say it is impossible to make those guarantees based on
the plans that the candidates have outlined so far … ‘It’s impossible to have an ‘ everybody wins’
scenario here,’ said Kenneth Thorpe, chairman of the health policy department at Emory University …
‘There’s no question it hits the middle class,’ he added. John Holahan, a health policy expert at the
nonpartisan Urban Institute agreed: ‘Even though high-income people are going to pay a lot more, this
has to hit the middle class .’… ‘Most of the proposals to move to Medicare-for-all would involve
substantial tax increases that would affect most people ,’ said Katherine Baicker, an economist at the
University of Chicago who specializes in health policy. ‘These are going to be big tax increases .’ … ‘I
think it seems likely under most proposals taxes would have to go up substantially unless you
dramatically cut the health care you’re getting,’ she added,” The Washington Post reports.
And, “economists say that most taxpayers would pay more in taxes than they would save from having the
federal government absorb the cost of health-care premiums,” The Post also reports. Additionally, “71%
of households with private insurance would wind up paying more than they would under the current
system,” Kenneth Thorpe, chairman of the health policy and management department at Emory
University, told The Wall Street Journal.
Meanwhile, a study by Tom Church, Daniel L. Heil, and Lanhee J. Chen, Ph.D. of the Hoover Institution
with support from the Partnership for America’s Health Care Future reveals that the public option – often
branded a “moderate” alternative to Medicare for All – “could require tax increases on most Americans,
including middle-income families” and could “add over $700 billion to the 10-year federal deficit, with
dramatically larger losses in subsequent years.”

According to the new study, “a politically realistic public option would add over $700 billion to 10-year
deficits. By 2049, the plan would increase long-run debt projections by 30 percent of GDP or require
tax increases equal to nearly 20 percent of projected income tax revenue . These tax increases may
affect even middle-income taxpayers, raising their marginal income tax rates by several percentage
points.” This would make the public option “the third largest line item on the federal budget, behind only
Medicare and Social Security.”
Economists agree, that the public option would burden American families with unaffordable costs .
“The public option would cause premiums for private insurance to skyrocket ,” Dr. Scott Atlas of
Stanford University writes in The Wall Street Journal. “A single-payer option is not a moderate,
compromise proposal. Its inevitable consequence is the death of affordable private insurance … Massive
taxation would be needed to expand Medicare, whether optionally or not,” Atlas continues.

Economic decline causes nuclear war – causes escalation in the Middle East and
Ukraine – COVID is uniqueness for our impact because it puts global stability on
the brink.
Christian ’23 (Cornelius Christian previously taught economics at Brock University and St. Francis Xavier University, he holds a BA in
Economics from the University of Alberta, and a MPhil and DPhil in Economics from the University of Oxford; 1/18/2023; “The bottom is in for
gold - World War 3 is already here & a global economic collapse will pave way for CBDCs - Gerald Celente ,”
https://www.kitco.com/news/2023-01-18/The-bottom-is-in-for-gold-World-War-3-is-already-here-a-global-economic-collapse-will-pave-way-
for-CBDCs-Gerald-Celente.html)//LASA-AB

Celente's optimistic prognosis for gold is due to his grim macroeconomic outlook, as well as gold's role as a hedge against financial instability.
He claimed that 2023 would witness a "market
meltdown," and suggested that the U.S. government would use war to
distract its citizens from the harsh economic reality.
"This is very important… we're talking about a market meltdown [in 2023]," said Celente. " The
only thing that's keeping the
markets up are interest rates. They go high, and the market goes down. When all else fails, they take you
to war."
He added, suggesting gold's role as a geopolitical risk hedge, that "if the current events, that are forming future trends, continue to escalate
into war in Ukraine and the Middle East, then gold goes through the roof."
Indeed, Celente plainly stated that World War III is here due to the global nature of the Russia-Ukraine conflict .
World War III

"This is not a proxy war," said Celente, commenting on the ongoing Russia-Ukraine conflict. " America is at war with Russia.
They're sending in [American] troops, to train them [Ukrainians] to use the weapons that we're giving them."

In November of 2022, the Pentagon confirmed that active U.S. troops are in fact on the ground in Ukraine to "assess weapon
stocks" and provide training. Celente suggested that this could escalate into a hot war between the U.S. and Russia.
"This is called mission creep," said Celente. "They are already pumping [fears] of a nuclear bomb."

He suggested that a " nuclear exchange " is likely as tensions rise between NATO and the BRICS countries.

"The war is going to continue to escalate unless we talk about peace," he said. "I am saying it could escalate into it [a nuclear war]."
Global Economic Woes

Fears heightened last year of a crisisin emerging-market debt, much of it denominated in dollars, as the U.S. dollar gained in
value against other currencies. Celente forecasts that emerging markets will face debt crises this year as the global
economy collapses.
"Emerging markets are submerging really deeply," he observed. "They have all this debt, a lot of it is dollar-based, and the
dollar is still much stronger than it was before."

The U.S. dollar index (DXY) is up 6.95 percent from last year.
Celente, using the example of commercial real estate, also pointed to the damage from COVID lockdowns.
"You're looking at office occupancy rates… at best it's 50 percent of what it was before the COVID war," he said. "All of the businesses that
depended on commuters are going out of businesses."

He said that landlords who own office real estate would struggle to pay their mortgages, as occupancy rates go down and interest rates rise.

Celente suggested that the damage done by COVID lockdowns was incalculable, and that stock markets do not reflect these
deeper economic trends.

"Kids are going out of their minds from what happened with the lockdowns," he claimed. "You have drug dealers and crime [going up], one thing
after another. The economic situation is only artificially being covered up by the markets… people are taking second jobs
and third jobs that pay very low wages because 63 percent of Americans are living paycheck-to-paycheck."

CBDCs

As the global economy worsens, governments worldwide will have an excuse to roll out Central Bank Digital Currencies
(CBDCs), programmable digital tokens controlled by a central bank, said Celente.

"They're going to use this as an excuse to come up with a new currency," he said. "They [governments] have all this debt and they've got to wash
it out with a new currency."

He stressed that he was particularly worried about CBDCs' potential to track peoples' spending and increase their tax burdens.

"With a digital currency, they know every penny that you spend, where you spent it, and what you spent it on," he observed. "They'll have more
control over you but most importantly, they'll get every penny from you in tax dollars."
 Biotech DA
Bio-tech innovation is on the rise now – Biden initiatives
Rugaber 22 [Christopher; 9-12-2022; "Biden to announce new support for U.S. biotech production in Boston"; No Publication;
https://www.wbur.org/news/2022/09/12/president-biden-cancer-moonshot-research-jfk-library;]//LASA-‫بيالل‬

President Joe Biden

is launching a new initiative to encourage biotech production and research in the U.S.,
the latest move by the White House to boost domestic industry.
Biden on Monday signed an executive order implementing the initiative and later, in remarks at the John F. Kennedy
Presidential Library in Boston, will address how biotech can help fight cancer. On Wednesday, the Democratic president's administration will
host a summit and announce new investments from several federal agencies, according to a White House fact sheet.

The initiative will seek to boost biomanufacturing in pharmaceuticals but also in other industries such
as agriculture, plastics and energy . A senior administration official wouldn't say how much funding will be announced
Wednesday.

Biomanufacturing processes can program microbes to make specialty chemicals and compounds , the fact
sheet said. Biomanufacturing can be used to make alternatives to oil-based chemicals, plastics and textiles.

The executive order follows bipartisan legislation Biden signed last month that provided $52 billion to
subsidize the production of semiconductors, construction of new chip plants and research and development in the United States.
That legislation was intended to reduce the U.S. economy's reliance on semiconductors made overseas, particularly in Taiwan, and to respond to
greater efforts by China to develop its own chip industry.

Biden touted the benefits of the semiconductor law on Friday, in a stop in Columbus, Ohio, where chip giant Intel has broken ground on a new
$20 billion factory.

The administration official, who wasn’t authorized to speak publicly and insisted on anonymity, said the
White House wants to
support manufacturing biotech products that are developed in the U.S ., rather than seeing American
innovations produced abroad .

“We’re aiming to expand domestic biomanufacturing capacity so that more of what’s invented in America
is made in America,” the official said. "Other countries, including and especially China, are aggressively
investing in this sector, which poses risks to U.S. leadership and competitiveness .”

Medicare expansion destroys biotech innovation

Evers-Hillstron 19 [Karl; Karl Evers-Hillstrom covers business and lobbying for The Hill; 3-7-2019; "Big Pharma, insurers,
hospitals team up to kill Medicare for All"; OpenSecrets News; https://www.opensecrets.org/news/2019/03/big-pharma-insurers-hospitals-team-
up-to-kill-medicare-for-all/;]//LASA- ‫بيالل‬

Pharmaceutical manufacturers and health insurance companies don’t agree on much these days. As
Congress introduces bills to address rising drug prices, insurers and pharmacy benefit managers are
engaged in a lobbying and public relations war with drugmakers over who is to blame.

But the giants of the healthcare industry agree on one thing: Medicare for All cannot become law .
Partnership for America’s Health Care Future (PAHCF), a group comprised of major drugmakers, insurance companies and private
hospitals, has spent the last several months lobbying members of Congress, running online ads and working with the media

to drive down popularity of Medicare for All , a single-payer health platform that continues to gain popularity in the Democratic party.

The partnership
includes some of the biggest names in the healthcare industry, including the American Medical Association
(AMA), Pharmaceutical Research & Manufacturers of America (PhRMA), Federation of American
Hospitals (FAH) and Blue Cross/Blue Shield.
All told, the members
of the partnership have a lot of money and influence to spend on Capitol Hill. They spent a combined $143
million lobbying in 2018 alone, according to data from the Center for Responsive Politics.
The development of a broad anti-Medicare for All coalition isn’t surprising. As with every time a major U.S. health care
reform bill is discussed, industry giants have a lot to lose and a major incentive to fight back.

John McDonough, a Harvard health professor who helped craft the Affordable Care Act (ACA), would hear from industry lobbyists every day as he worked on the
bill. He noted the final version of the bill — with many concessions, including the removal of a public option — passed with support from major industry
players including PhRMA, AMA and FAH — all of whom now oppose Medicare for All .
“I think, quite honestly, given how close we were to losing the whole thing, had the pharmaceutical industry been on the other side of the fence in 2010 there never
would have been an ACA,” McDonough said. “It would’ve been an afternoon’s work for them to kill it.”

Medicare for All is different, McDonough said, because there isn’t as much room for lawmakers to make
concessions. Depending on the version of the bill, it would likely create stricter regulation on drug prices,
eliminate the need for some private insurers and cut the bottom line for hospitals that rely on private
insurance reimbursement rates.
“When you point a gun at somebody and say ‘we’re gonna kill you,’ don’t be surprised when they fight
like it’s life or death,” McDonough said. “The ACA was not life or death for the insurance industry. Medicare for All is a death
notice for a large chunk of the U.S. healthcare industry and they know it.”
An insurance industry insider told The Hill in 2018 that the group had originally planned to stop Medicare for All from becoming a litmus test for Democrats in 2020.
The Intercept obtained an internal document noting its lobbyists were successful in getting congressional Democratic candidates to adopt the partnership’s “moderate”
position on health care such as improving the Affordable Care Act.

That strategy didn’t appear to work among Democratic presidential candidates though, as many major 2020 contenders, including Sens. Kamala Harris (D-Calif.),
Bernie Sanders (I-Vt.), Elizabeth Warren (D-Mass.) and Cory Booker (D-N.J.), support the health care overhaul.

PAHCF recently launched efforts to get the public on their side. The group has spent at least $80,594 on Facebook ads since it released its first ads in late January and
at least $13,000 on Twitter ads.

According to Twitter’s ad transparency database, the partnership is using FP1 Strategies, an Arlington, Virginia consultant that took in $18 million from conservative
groups in 2018, to place at least some of its ads.

Though it might be best known for producing ads that helped take down Democrat Randy Bryce in the 2018 Wisconsin 1st District race, FP1 has delved into the
healthcare world before.

Among FP1’s 2018 clients was New Yorkers for Excellent Health Care, a new super PAC funded by Greater New York Hospital Association management that spent
$341,093 in support of former Rep. Dan Donovan (R-N.Y.). The firm also notes it helped the Consumer Healthcare Products Association defeat legislation to require
prescriptions for certain medications.

PAHCF isn’t the only group working to defeat Medicare for All — its allies began their campaigns long
ago and will continue to do so. America’s Health Insurance Plans, for example, announced a six-figure ad
campaign in June 2018 to spotlight millions of Americans covered by employer-provided health
coverage. PAHCF has repeated similar numbers in its public relations push.
Medicare for All is up against serious challenges — and it’s unclear whether the measure has enough muscle, or money, behind it.

Though the bill has drawn praise from several major unions, including National Nurses United, National Union of Healthcare Workers, American Federation of
Teachers and Service Employees International Union, few industry groups — outside of those dedicated to backing single-payer health care —
publicly support the bill.
The Medicare for All bill (H.R.1384) introduced by Rep. Pramila Jayapal (D-Wash.) on Feb. 27, has 106 co-sponsors in the House, far fewer than it needs to pass. It
does not have the support of House Democratic leaders.

Every attempt to completely overhaul the healthcare system has failed or become watered down
due to opposition from the healthcare industry , from President Harry Truman’s universal health care plan in 1949 to President Bill
Clinton’s universal health care plan in 1993. Supporters of Medicare for All are hoping this time will be different.

Synthetic Biology innovation causes extinction

Lohr 11/23 – Quoting Endy, Professor of Bioengineering, Stanford University
Steve Lohr, Quoting Drew Endy, professor of bioengineering at Stanford University, 23 November 2021,
https://www.nytimes.com/2021/11/23/business/dealbook/synthetic-biology-drew-endy.html
Synthetic biology holds great promise, but there is a dark side as well. Hacking biology and
democratizing the tools to do so raises the specter of an angry loner or terrorist group creating a
build-your-own pandemic genetically targeted at their enemies, among other potential horrors.
Mr. Endy, though synthetic biology’s champion, has been cleareyed about the risks since the outset. He
was the lead author of a report for the Pentagon’s advanced research agency in 2003 that laid out a
framework for developing synthetic biology and managing its risks. In the report, he assessed the
spectrum of dangers and imagined the bad-actor threat as “Bin Laden Genetics.”
Today, risk management, Mr. Endy said, should start with the assumption that in the not too distant
future “anyone, anywhere can make any virus from scratch.”
One line of protection is synthetic biology itself. For example, Mr. Endy points to the possibility of
advanced technologies like engineered chromosomes that would give humans a built-in defense
system, say, against the world’s top 20 pathogens.
 HEALTH

1. Burnout and geographic dispersion check disease.

Sebastian Farquhar 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

2. ALT CAUSES. Their TFAH card says health misinfo, lack of vaccination, state
governance issues, and lack of hospitals cause the spread of disease.

3. Disease can’t cause extinction

Dr. Toby Ord 20, Senior Research Fellow in Philosophy at Oxford University, DPhil in Philosophy
from the University of Oxford, The Precipice: Existential Risk and the Future of Humanity, Hachette
Books, Kindle Edition, p. 124-126

Are we safe now from events like this? Or are we more vulnerable? Could a pandemic threaten humanity ’s future?10
The Black Death was not the only biological disaster to scar human history. It was not even the only great bubonic plague. In 541 CE the Plague
of Justinian struck the Byzantine Empire. Over three years it took the lives of roughly 3 percent of the world’s people.11

When Europeans reached the Americas in 1492, the two populations exposed each other to completely novel diseases. Over thousands of years
each population had built up resistance to their own set of diseases, but were extremely susceptible to the others. The American peoples got by far
the worse end of exchange, through diseases such as measles, influenza and especially smallpox.

During the next hundred years a combination of invasion and disease took an immense toll—one whose scale may never be known, due to great
uncertainty about the size of the pre-existing population. We can’t rule out the loss of more than 90 percent of the population of the Americas
during that century, though the number could also be much lower.12 And it is very difficult to tease out how much of this should be attributed to
war and occupation, rather than disease. As a rough upper bound, the Columbian exchange may have killed as many as 10 percent of the world’s
people.13

Centuries later, the world had become so interconnected that a truly global pandemic was possible. Near the end of
the First World War, a devastating strain of influenza (known as the 1918 flu or Spanish Flu) spread to six continents, and even remote Pacific
islands. At least a third of the world’s population were infected and 3 to 6 percent were killed.14 This death toll outstripped that of the First
World War, and possibly both World Wars combined.

Yet even events like these fall short of being a threat to humanity ’s longterm potential.15
[FOONOTE]

In addition to this historical evidence, there are some deep er biological observations and theories
suggest ing that pathogens are unlikely to lead to the extinction of their hosts. These include the
empirical anti-correlation between infectiousness and lethality , the extreme rarity of diseases that
kill more than 75% of those infected, the observed tendency of pandemics to become less virulent as
they progress and the theory of optimal virulence . However, there is no watertight case against pathogens leading to the
extinction of their hosts.

[END FOOTNOTE]

In the great bubonic plagues we saw civilization in the affected areas falter, but recover . The regional 25
to 50 percent death rate was not enough to precipitate a continent-wide collapse of civilization. It
changed the relative fortunes of empires, and may have altered the course of history substantially, but if anything, it gives us reason to
believe that human civilization is likely to make it through future events with similar death rates, even
if they were global in scale.
The 1918 flu pandemic was remarkable in having very little apparent effect on the world’s development despite its global reach. It looks like it
was lost in the wake of the First World War, which despite a smaller death toll, seems to have had a much larger effect on the course of history.16

It is less clear what lesson to draw from the Columbian exchange due to our lack of good records and its mix of causes. Pandemics were clearly a
part of what led to a regional collapse of civilization, but we don’t know whether this would have occurred had it not been for the accompanying
violence and imperial rule. The
strongest case against existential risk from natural pandemics is the fossil record
argument from Chapter 3. Extinction risk from natural causes above 0.1 percent per century is incompatible
with the evidence of how long humanity and similar species have lasted. But this argument only works where the
risk to humanity now is similar or lower than the longterm levels. For most risks this is clearly true, but not for pandemics. We have done many
things to exacerbate the risk: some that could make pandemics more likely to occur, and some that could increase their damage. Thus even
“natural” pandemics should be seen as a partly anthropogenic risk.

4. No Bioweapon threat---empirical consensus, technical challenges, and no

scenario for extinction.
Marc-Michael Blum 20. Dr. Blum is working the in the field of analysis, decontamination,
countermeasures and mitigation of chemical warfare agents with more than 15 years’ experience. "Corona
and Bioterrorism: How Serious Is the Threat?" War on the Rocks. 6-22-2020.
https://warontherocks.com/2020/06/corona-and-bioterrorism-how-serious-is-the-threat/

The novel coronavirus pandemic has put the threat of bioterrorism back in the spotlight. White supremacist chat rooms are teeming with talk about “biological warfare.” ISIL even called the
virus “one of Allah’s soldiers” because of its devastating effect on Western countries. According to a recent memo by the U.S. Department of Homeland Security, terrorists are “[making]
bioterrorism a popular topic among themselves.” Both the United Nations and the Council of Europe have warned of bioterrorist attacks. How serious is the threat? There is a long history of
 the technical challenges associated with
terrorists being fascinated by biological weapons, but it is also one of failures. For the vast majority,

weaponizing biological agents have proven insurmountable. The only reason this could change is if terrorists were to receive support from a
state. Rather than panic about terrorists engaging in biological warfare, governments should be vigilant, secure their own facilities, and focus on strengthening international diplomacy. A

History of Failures Biological warfare, which uses organisms and pathogens to cause disease, is nearly
as old as war itself. The first known use of biological agents as a weapon dates back to 600 B.C., when an ancient Greek leader poisoned his enemies’ water supply. Throughout
the Middle Ages, especially during the time of the Black Death, it was common to hurl infected corpses into besieged cities. And during the two world wars, all major powers maintained

Among terrorists, however, the use of biological weapons has

biological weapons programs (although only Japan used them in combat).

been rarer, although groups from nearly all ideological persuasions have contemplated it. Recent examples include a plot to contaminate
Chicago’s water supply in the 1970s; food poisoning by a religious cult in Oregon in the 1980s; and the
stockpiling of ricin by members of the Minnesota Patriot Council during the 1990s. No one died in any
of these instances. The same is true for the biological warfare programs of al-Qaeda and the Islamic State
group. Both groups have sought to buy, steal, or develop biological agents. For al-Qaeda, this seems to have been a priority in the
1990s, when its program was overseen by (then) deputy leader Ayman al-Zawahiri, a trained physician. With the Islamic State, evidence dates back to 2014, when Iraqi forces discovered

Yet none of these efforts succeeded. The only al-Qaeda plot in which
thousands of files related to biological warfare on a detainee’s laptop.

bioterrorism featured prominently — the so-called “ricin plot” in England in 2002 — was interrupted at such an early stage that none of the

toxin had actually been produced. The Islamic State’s most serious attempt, in 2017, involved a small
amount of ricin, whose only fatality was the hamster on which it was tested. Of the tens of thousands of
people that jihadists have murdered, not a single one has died from biological agents. It may be no accident that the most
lethal bioterrorist attack in recent decades was perpetrated by a scientist and government employee. In late 2001, the offices of several U.S. senators and news organizations received so-called
“anthrax letters,” which killed five people and injured 17. Following years of investigation, the FBI identified the sender as Bruce Ivins, a PhD microbiologist and senior researcher at the U.S.
Army’s Medical Research Institute of Infectious Diseases. Unlike the others, he was no amateur or hoaxer, but a trained expert with years of experience and full access to the world’s largest

Technical Challenges Ivins’ case helps to explain why so many would-be bioterrorists have failed. At a technical
repository of lethal biological agents.

level, launching a sophisticated, large-scale bioterrorist attack involves a toxin or a pathogen — generally
a bacterium or a virus — which needs to be isolated and disseminated. But this is more difficult than it seems. As
well as advanced training in biology or chemistry, isolating the agent requires significant experience. It
also has to be done in a safe, contained environment, to stop it from spreading within the terrorist group.
Contrary to what al-Qaeda said in one of its online magazines, you can’t just make a (biological) weapon “in the kitchen of your

mom!” In addition, there is the challenge of dissemination. Unless the agent is super-contagious, a
powerful biological attack relies on a large number of initial infections in perfect conditions. In the case of the
bacterium anthrax, for example, only spores of a particular size are likely to be effective in certain kinds of weather.

State-sponsored programs often needed years of testing and experimentation to understand how their weapons

could be used. Though not impossible, it is unlikely that terrorist groups possess the resources, stable environment,
and patience to do likewise. Doomsday Scenarios Even if terrorists somehow succeeded, it is nearly
inconceivable that the resulting “weapon” would be as powerful as the recent coronavirus, SARS-CoV-2.
One of its uniquely devastating features has been that people are infectious while experiencing no symptoms. As it spread across the globe, there was no treatment, no vaccine, an incomplete
understanding of its pathological modes of action, and no easy, cheap and widely available testing. It was the viral equivalent of a “zero-day exploit” — a cyber-attack that happens before any

None of the viruses on the U.S. Centers for Disease Control and Prevention’s list of the most
patch is available.

dangerous biological agents could be easily “weaponized” or would have the same, devastating effects
as SARS-CoV-2. Pathogenic viruses such as smallpox, Ebola, Marburg, and Lassa are extremely hard to find,

isolate, and spread. Botulinum and ricin are dangerous toxins, but not contagious, while Tularemia cannot be transmitted
from human to human. The plague is, of course, capable of causing pandemics, but most countries are nowadays well prepared for this

particular virus, and will be able to limit — and cope with — localized outbreaks. This leaves only
anthrax, a soil bacterium which is relatively easy to obtain. Even so, isolating a highly pathogenic strain is difficult. More
importantly, anthrax is not contagious, and while its spores are durable and affected areas can be hard to de-contaminate, it is unable to
spread on its own. Regarding SARS-CoV-2, it is important to distinguish between the possibility that the virus occurred naturally and escaped from a laboratory, and the idea that
it was engineered for maximum infectiousness and deliberately released. The first remains a possibility, although other explanations are equally — if not more — plausible, while the second has

The
been debunked by a comprehensive examination in the journal Nature Medicine, which concluded that SARS-CoV-2 was “not a laboratory construct or a purposefully manipulated virus.”

chances that terrorists would be capable of engineering a virus such as SARS-CoV-2 without access to a
state’s resources are virtually zero. If anything, the possibility of a lab escape — however remote — highlights the importance of biosafety. While governments
have paid much attention to laboratories with the highest biosafety level (level 4), work on bat-born coronaviruses is regularly performed at lower levels (level 3, and even level 2), and should

instead be subject to similar safety requirements. In sum, small-scale attacks using anthrax or other agents may be possible, but
the risk of a highly advanced, weaponized pathogen that spreads among large populations — a terrorist-
initiated biological doomsday — is very low. The only exception, of course, is if terrorists received support from a state, acted as its proxies, or were able
to draw on its resources — as in Ivins’ case.
 GROWTH
Econ DA

1. Health care costs are stabilizing – most recent data

Dave Muoio 21, Fierce Healthcare, 6/21/21, Healthcare price increases slowing as utilization, personal
spending continue COVID-19 rebound, https://www.fiercehealthcare.com/finance/healthcare-price-
increases-decelerate-as-utilization-personal-spending-continue-covid-19

The Altarum Institute, a nonprofit research group, reported a 2% annual increase in overall healthcare prices for
May 2021 and a 1.9% increase for April 2021.

These growth rates had exceeded 2.5% for much of last year and ran as high as 2.7%. After a brief respite in the fall, healthcare price growth
again jumped over 2.5% early in 2021, according to the institute's data This
“noticeable deceleration and moderation ” in
price growth from April to May spanned each of the healthcare subcategories monitored by Altarum.
Hospitals and physician services retained the highest year-over-year price growth at 3.6% and 3.1%, respectively. Nursing home care and home
health care showed the greatest growth drop off during the pandemic, however, dropping from 4.7% to 2.1% and 3.6% to 1.5% year over year,
respectively.

The normalization of healthcare price growth stands out against other trends both inside healthcare and
across the broader economy , Altarum wrote.
For the former, personal healthcare spending increased 40.1% year over year in April while utilization jumped 38.2% year over year for the same
month.

Outside of the industry, Altarum highlighted a 5% year-over-year increase in the consumer price index and a 6.6% increase for the producer price
index during May (generally attributed to a combination of recovering demand for goods and services, Federal Reserve monetary policy and
supply constraints).

The research group floated two potential explanations why healthcare prices have so far bucked the broader economic trends.

“First, many of the supply constraints for healthcare inputs are likely less significant in 2021 than they were at the start of the pandemic when
many critical medical supplies were in severe short supply due to treating COVID patients,” Altarum wrote in the report. “Second, while the
demand for healthcare services may be increasing, the price for that care is likely less mutable in the short run as prices are set annually either by
governments (Medicare and Medicaid) or in longer-term contracts (private health insurance).

“The extent to which these factors continue to impact prices in 2021 and if healthcare price growth will remain below other sectors remains to be
seen,” the group wrote.

Altarum’s analyses are based on monthly data from the U.S. B ureau of L abor S tatistics.
This monthly report, published Thursday, came a day after another from the research group predicting the Food and Drug Administration’s
controversial approval of Aduhelm for Alzheimer’s disease treatment stands to single-handedly increase national healthcare expenditure by more
than 1%.

Meanwhile, a PwC Health Research Institute report released earlier this month suggested healthcare costs are likely to increase by 6.5% next year
due to continued COVID-19 impacts on spending.

2. Cost saving is a myth.

Robert Pearl MD, 3-27-2017 – physician and CEO, Permanente Medical Groups

[ "3 myths about a single-payer system and why it's doomed to fail," KevinMD,
http://www.kevinmd.com/blog/2017/03/3-myths-single-payer-system-doomed-fail.html ]
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.
Myth 2: It would reduce the cost of coverage
The basis for this claim is that other countries spend a lower percentage of GDP on health care — and the
assumption that if the government takes over health care, the same would happen in the U.S. But as we
saw in Vermont, the opposite is likely to happen.
The cost of health care is a combination of how many services are performed and how much each costs.
When the government can set prices, it can decrease what it pays for each service, but that does not mean
overall costs decline. Instead, as has happened around the globe, private insurers enter the market. In
response to the higher payments offered, doctors and hospitals put these privately insured patients at the
front of the line. And those physicians who continue to accept the governmental rates start doing more to
make up for the lost income.
We saw this approach fail when the federal government enacted the Balanced Budget Act of 1997. This
legislation required health care inflation to rise no faster than GDP. To accomplish this, payments to
doctors were theoretically reduced proportionately through the Sustainable Growth Rate calculation
(SGR). But each year, the reductions were not applied due to the political backlash. By the time the
requirement was lifted, the gap between what was paid and what would be required to match inflation
exceeded 20 percent.
Myth 3: It would provide insurance coverage to all
Champions of a single-payer emphasize that even with implementation of the Affordable Care Act,
millions of Americans still lack health coverage — and they see single-payer as a solution. They argue
that if the government created a single payer option, similar to what Medicare today provides to people
over the age of 65, all eligible Americans would have an insurance card. But the question is, What would
be the value of that coverage in the future?
Health care costs are rising faster than our ability to pay and, as a result, prices are increasing in parallel
at an accelerated rate. This is a fundamental business truism. Over time, price and cost must parallel each
other. The drivers of cost inflation are drug prices rising at double-digit rates, new medical technology
increasing expenditures on procedures, wages going up in response to labor shortages, and expensive
regulatory requirements. Price controls in this environment can’t work.
Soon after implementation of a government-run, single-payer system, Congress would have to
progressively increase taxes, reduce payments to doctors and hospitals, or do both. The former won’t be
palatable to the American people or the current Congress, and the latter will result in a two-tier system,
with prolonged delays in access for those without added private coverage. This is what exists today in
most countries that have implemented a government-run, single-payer system. We can get a glimpse of
this by looking at the difference in care provided to the poor through Medicaid. Over time, if our nation
tried this approach more broadly, that would become the experience of the middle class as well.

3. Inequality is declining now – proves their theories surrounding it is bunk

Falk 20 – Jeff Falk is director of national media relations in Rice University's Office of Public Affairs.
Jeff Falk, October 28 2020, “US wealth, income inequality has declined, Baker Institute expert finds,”
Rice University, https://news.rice.edu/2020/10/28/us-wealth-income-inequality-has-declined-baker-
institute-expert-finds-2/

Analysis of Federal Reserve survey data shows U.S. wealth inequality has declined for the first time in
nearly 30 years, while income inequality has seen its largest decline in three decades, according to a
new working paper from Rice’s Baker Institute for Public Policy.
The results come from the Survey of Consumer Finances (SCF), a triennial family survey conducted by
the Federal Reserve. The survey data for 2019, which was released in late September, gives one of the
best insights into U.S. households’ wealth composition , said Jorge Barro, fellow in public finance at
the Baker Institute and author of the paper, titled “Decline in U.S. Wealth and Income Inequality Between
2016 and 2019.”

What makes the shift particularly surprising is that it comes after a significant tax cut signed into law
in 2017, Barro said. This tax reform, commonly known as the Tax Cuts and Jobs Act (TCJA), reduced
the corporate tax rate from 35% to 21%.
“Given that this tax cut largely benefited those who hold corporate equity, many expected this change
would actually increase wealth and income inequality,” Barro wrote. “A recent working paper at the
National Bureau of Economic Research, however, notes that higher corporate taxation shifts corporate
income to noncorporate businesses, increasing the dispersion of income and generating a rise in income
inequality — an outcome that would reverse with a decline in the corporate tax rate.”

Wealth inequality rose persistently between 1992 and 2016 — a trend that saw a reversal in 2019, Barro
found. “Income inequality also experienced the largest decline since 1992,” he wrote. “Both changes are a
result of gains in the total shares (of wealth and income) by lower deciles (groups). While there are many
plausible explanations, changing age demographics and the economic impact of the TCJA may have
played a role in generating this outcome.”
Barro said an aging of the population shifts the age distribution from a large share of young and a low
share of old to a low share of young and a large share of old. Because people generally have low assets
early in life and higher assets later in life, this demographic shift can alter the wealth distribution from
fewer high-wealth individuals to relatively many high-wealth individuals. Consequently, an aging of the
population can plausibly generate a reduction in wealth inequality.
The SCF collects granular data on the financial positions of U.S. families, with regards to assets and
liabilities. The extent to which a family’s assets exceed their liabilities determines their net worth, which
in turn defines the family’s wealth. Between 2016 and 2019, real median family wealth grew 17.7%
from $103,460 to $121,760 . Even as broad measures of wealth grew over this time period, the dispersion
of wealth contracted, Barro said.

Between 2016 and 2019, real median U.S. family income rose 5.4% from $56,019 to $59,051 . Over
that period, income inequality experienced its sharpest decline since the decline between 1989 and 1992,
Barro said.
Rising wealth and income inequality have been focal points in debates in the economics profession for
many years, Barro said. “Researchers and institutions have allocated considerable resources to
understanding the causes of inequality and how policy can affect it. A decline in both income and wealth
inequality between 2016 and 2019 will require researchers to rethink the mechanisms driving
inequality.”

Barro’s area of research involves the development of dynamic macroeconomic models for fiscal policy
evaluation. Prior to joining the Baker Institute, Barro was an economist at the University of
Pennsylvania’s Wharton Public Policy Initiative, where he led the development of its dynamic
macroeconomic model and helped launch the nonpartisan Penn Wharton Budget Model.

4. No reverse causal solvency – their evidence says price inflation across the
economy is outpacing wage growth – heath care isn’t key.
5. No impact to inequality.
Elise Must 16, PhD student at LSE, this was her PhD thesis, “When and how does inequality cause
conflict? Group dynamics, perceptions and natural resources”,
http://etheses.lse.ac.uk/3438/1/Must_When_and_how_does_inequality.pdf
Does economic inequality lead to conflict? This question has attracted the attention of prominent scholars at least since the time
of Aristotle (Nagel 1974). The frequent assumption that unequal distribution somehow fuels rebellion has resulted in a vast amount of theoretical
as well as empirical work. For long, results remained mixed. Despite countless qualitative studies asserting that inequality is a major
reason for conflict outbreak, quantitative studies struggled to establish a firm relationship between the
two (Blattman and Miguel 2010, Cramer 2005, Lichbach 1989). These quantitative studies, including the most influential ones by
Collier and Hoeffler (2004) and Fearon and Laitin (2003), rely on analysis of individual measures of inequality. However,
as most prominently set forth by Frances Stewart, it is minority groups or collectives of individuals who
rebel, not the whole population, nor individuals (Stewart 2002). Stewart’s theoretical development has given rise to several
quantitative studies which uniformly support the role of economic group inequality in inducing conflict (Buhaug, Cederman, and Gleditsch 2014,
Cederman, Weidmann, and Bormann 2015, Cederman, Weidmann, and Gleditsch 2011, Deiwiks, Cederman, and Gleditsch 2012, Østby 2008a, b,
Østby, Nordås, and Rød 2009). Hence, there is an emerging consensus in the literature that inequality causes civil conflict when it overlaps with
relevant group identities. Promising as these studies are, they nevertheless neglect a potential crucial part of the inequality-
conflict causal chain. Seemingly all studies of inequality and conflict, including those measuring group inequalities, are
based on objective inequalities. Yet, as Stewart (2010, 14) herself notes, ‘People take action because of perceived
injustices rather than because of measured statistical inequalities of which they might not be aware’.
Economic inequality measured by the Gini coefficient, or by local GDP data, is most commonly used as proxies, leaving
completely aside how economic inequality is actually interpreted and perceived by both groups and
individuals (ref. Zimmermann 1983). It remains obvious, however, that in order for people to take action to address inequalities, the first
step is to recognize them and to consider them unjust (Han et al. 2012). The use then, of objective measures in current empirical studies, is based
on the assumption that both objective and perceived horizontal inequalities essentially amount to the same thing. Put another way it is assumed
that all objective inequalities are actually perceived as inequalities by relevant groups, and conversely all perceived inequalities have an objective
basis. These are strong claims that are so far largely untested. Existing studies of the link between objective and perceived horizontal inequalities
range from concluding that there is no such link (Langer and Smedts 2013) to documenting imperfect correlations – ranging from 0.27 to 0.30
depending on indicators and datasets (Holmqvist 2012). While cross-country analyses of conflict have neglected
perceptions of inequality, the case study literature does offer some examples demonstrating their importance. Interviewing Muslim
immigrants in London and Madrid, Gest (2010, 178) finds that what distinguishes democratic activists from those who engage in anti-system
behavior, is the nature of their individual expectations and perceptions about shared economic realities. Moving on to larger conflicts, a recent
World Bank report concludes that the so called ‘Arab Spring’ was driven by a decrease in popular subjective satisfaction, while the objective
economic situation actually improved in the years before the widespread mobilization (Ianchovichina, Mottaghi, and Shantayanan 2015). The
report also points to the importance of inter-group inequality as opposed to individual inequality. My main argument is that in order to better
capture the role of inequality in inducing civil conflict, measures have to account for relevant groups as well as for the
perception of inequality in these groups. In addition, my analyses fill two other gaps in the literature. While Stewart emphasizes
how groups can mobilize around different identities, current studies have almost exclusively focused on ethnic groups. However, a regional
identity might be just as relevant (ref. Posner 2004). I will therefor look at the effect of regional economic inequality on civil war. And finally,
most of the studies, and all of those with a global scope, rely on time invariant measures of economic horizontal inequality. This is commonly
defended by referring to the demonstrated ‘stickiness’ of horizontal inequalities (see e.g. Stewart and Langer 2008, Tilly 1999). Still, a recent
study covering 1992 to 2013 demonstrates a global decline of ethnic inequality (Bormann et al. 2016), while Kanbur and Venables (2005)
compare case studies of 26 developing countries and conclude that regional inequalities are rising. The data used in this analysis also show that
horizontal inequalities change quite substantially over time. Using inequality data from one particular year to analyze decades of conflict
incidents is therefore questionable. Hence, my study represents the first time-variant analyses of the effect of both objective and perceived
regional inequality on civil war covering developed and developing countries in all world regions14 . Analysing data for the period
1989 to 2014 from the World Values Survey (WVS), I find that countries with a high level of perceived regional
economic inequality have an elevated risk of civil war outbreak. On the other hand, mere objective regional economic
inequalities do not have any significant effect. The group aspect remains essential, as neither objective nor perceived
individual inequality is linked to increased civil conflict risk.
2NC
 Econ DA
Economic collapse turns the case.
1. INEQUALITY – decline causes it.
BIS 21 – Bank for International Settlements
“2021 Annual Economic Report,” Bank for International Settlements, June 2021,
https://www.bis.org/publ/arpdf/ar2021e.pdf
Inequality and recessions

Recessions are particularly harmful for the most disadvantaged because unemployment tends to hit
unskilled workers harder and for longer . The experience during the Covid-19 pandemic is a case in point: low-
income earners were the first to be laid off (Graph II.6, left-hand panel) and often faced significant difficulties
when trying to re-enter the labour market (centre panel).13 Even when successful, unskilled workers might be
forced to accept jobs paying lower salaries and offering fewer advancement opportunities compared with
their pre-recession jobs. The impact of weak economic activity on income inequality, while initially small, tends to grow
over time (Graph II.6, right-hand panel). A stylised exercise illustrates this by tracing out the effect of an increase in unemployment, as typically
experienced during recessions. Estimates point to an only slight increase in income inequality in the short run that then rises
substantially over time .

2. HEALTH – The speed wrecks hospitals.

Megan Mcardle 17, Bloomberg View, 6-9-2017, "Why not try “Medicare for all”? Glad you asked,"
Denver Post, http://www.denverpost.com/2017/06/09/why-not-try-medicare-for-all-glad-you-asked/
For one thing, as Obamacare has shown, “people will be paying for it, not the government, so what’s the problem?” is not quite as simple as it sounded when you were
saying it in front of a room of cheering supporters. For whom is it likely to be a good deal? Sick people. Medicare can adjust the buy-in
premium to take account of this, but then next year, folks are going to be looking at the new higher premiums, and who is likely to opt in at that high price? The
sickest folks in the insurance pool. Better adjust those premiums again … Yes, it’s our old friend, adverse selection, which pops up
whenever you build an insurance market without underwriting. Medicare is a government program, so it
can’t death spiral out of existence. However, there will be considerable political pressure to set the
premiums well below the expected actuarial expenditure on care for beneficiaries. So instead of a death
spiral, you get a fiscal crisis in Medicare. Yet here’s a measure of how badly thought out this idea of expanded Medicare is: Adverse
selection isn’t even its biggest problem. A far bigger problem is what this might do to hospital budgets.
Why? Because Medicare doesn’t necessarily pay enough to keep those hospitals running . Deep in the weeds of
health wonkdom, a long battle has been going on over whether — and to what extent — Medicare controls its costs by offloading them
onto private insurers, a phenomenon called cost shifting. Conservatives often promote a somewhat simplistic version of this argument:
Medicare pays too little, so hospitals have to charge insurers more to make up the lost reimbursements. As stated, this is probably wrong. The
empirical evidence to support it is weak, and even just theoretically, this misunderstands how market
actors behave. It treats costs as a budget problem: Companies have to cover certain costs, and if one
customer pays less, another customer has to pay more. (Liberals often make this mistake in reverse when talking about drug prices,
assuming that if the U.S. cracked down on pharmaceutical reimbursements, European governments would have to raise their reimbursements to make up for the lost
In fact, economists generally assume that
cash, thereby ending their free riding on the new drugs produced from U.S.-derived profits.)

sellers are charging each buyer as much as they can. Having one customer refuse to pay so much
doesn’t make your other customers more willing to pay, so there’s no reason to think that you’ll be
able to raise the price you charge them. However, there remains an undeniable fact: Medicare pays
significantly less than private insurers. And this can’t simply be explained by the fact that Medicare covers a huge number of people, because so
do Aetna and Humana and Anthem and Blue Cross. There’s some evidence that Medicare reimbursements don’t quite cover
the average cost of having a patient in the hospital. The hospital’s fixed costs are mostly getting covered by higher reimbursements from
private payers. (Though this varies by hospital, and is difficult to tease out, and therefore disputed.) Note that this isn’t necessarily somehow “cheating.” There are
plenty of people flying around the country whose fares don’t cover the average cost of their flight. It still makes good economic sense to sell them tickets at low fares,
In businesses
because the airlines are getting more revenue from a cheap ticket than from an empty seat. Ditto hospitals deciding whether to have empty beds.
like this, people often look at the prices paid by marginal-cost consumers, and conclude it would be great
if everyone got that price. But someone has to cover those fixed costs, or the seller goes bankrupt. Data from
the Medical Expenditure Panel Survey suggests that people on Medicare account for about a third of all national health expenditures; folks 44 to 65 for another third;
and the rest of us for the final third. And those folks are the ones most likely to use hospitals, because they’re more likely to be really sick, not just getting an annual
checkup and a few pills. If we followed Hillary Clinton’s plan, and lowered the Medicare eligibility age, one effect would be to take some pressure off Obamacare’s
exchanges, by moving the sicker and older patients out of the pool. But that cost has to go somewhere, and where it’s likely to end up is in hospitals, as their patient
load shifts dramatically toward lower-reimbursed Medicare patients. Like
the critics of the cost-shifting thesis, I doubt that
hospitals could simply turn around and jack up rates to private payers. On the other hand, I do kind of
wonder what the hospitals would do to cover the now gaping holes in their budgets. Hospital profit
margins are in the low-to-mid single-digits, which is probably not enough to absorb a large loss.
One thing they might do is go bankrupt . Ha! I’m kidding. Hospitals are politically powerful. They’d ask for,
and get, a bailout from the government, because no lawmaker is going to let the local hospital close. But that would make this
program pretty expensive , because that bailout would most likely involve moving all Medicare
reimbursements closer to what private payers pay. Or they also might refuse to handle so many Medicare
patients (a phenomenon you see among doctors, though doctor opt-out is nowhere near as bad as it is with Medicaid, which basically tries to pay doctors in cigar
bands). Of course, you can’t turn away someone who’s having a heart attack. But you could, say, decide that you’re only doing so many Medicare-funded knee
replacements a year. That would fix the budget problem. But all those folks with bad knees are apt to get pretty
cranky while waiting for a hospital bed. And of course, hospitals could cut costs. There’s evidence that this is what they
have done, in response to previous cuts in Medicare reimbursement. Unfortunately, there’s also some evidence that mortality

might have gone up as a result, as hospitals cut back on service quality . That may be a tradeoff we’re willing to make
for lower health care costs, but it should be explicitly discussed. And just because hospitals may have successfully cut costs in
response to a previous round of reimbursement cuts doesn’t mean we can necessarily expect that to work
again. Cost cutting is like dieting — the first few pounds of fat go easy, but getting to that perfect
size 10 may never happen. Those hospitals that do get there would probably have to result to
draconian measures — which might result in patient lives lost. So how you feel about this proposal
should probably depend on how sure you are that there are vast, easily obtained cost efficiencies to be had
in hospital operations. Myself, I’d want to be a lot surer than I am before I started running a mass
experiment, for our nation’s physical and fiscal health.

The signal alone spills over.

Daniel Summers 16, pediatrician in the greater Boston area., 2-19-2016, "I’m a Doctor. Here’s Why I
Oppose the Single-Payer Revolution.," New Republic, https://newrepublic.com/article/130145/im-doctor-
heres-oppose-single-payer-revolution
What is not disputed to any great degree is that Sanders
would reduce payments to doctors and hospitals. His “Medicare for all” plan
I have
would result in a substantial reduction in revenue compared to what most private insurance plans currently pay. As a pediatrician in private practice,

grave concerns that implementing a rapid transition to a single-payer system would be far more disruptive to many
Americans’ health care than Sanders cares to discuss. An incremental increase in Medicare eligibility would create a
de facto public option , the lack of which was my single greatest objection to the Affordable Care Act. But in order for Medicare to become a single-
payer system for everyone, patients must be left with no option. Sanders’s plan, presumably accomplished through legislative action, would require the summary
voiding of every contract medical providers have with all the insurance plans they accept. Even in the unlikely event that Sanders gets this plan through a recalcitrant
Congress, it is anyone’s guess whether it would withstand the wave of lawsuits that would doubtless ensue. But even if the plan survives these practical challenges, it
makes a mockery of the notion that people can keep the plan they have if they’re happy with their current coverage, one of the ACA’s biggest selling points (for which
President Barack Obama got into some trouble when those promises fell short). Whether or not I could still refer patients to the specialists I typically prefer, chosen
because my practice trusts the quality of care they deliver, would be in question. Controlling medical expenditures is a necessary goal, no matter what health care
system we have, but putting everyone on the same plan without acknowledging restricted choices as an inevitable consequence isn’t telling the whole story. Compared
to the lustrous ideals that inform the pursuit of a single-payer system, talking about profitability seems downright grungy. But businesses need to stay
profitable in order to stay afloat, and medical practices are no different. Even not-for-profits need sufficient revenue to keep the doors open.
Talking about substantially reducing payment to medical providers in one fell swoop, as though doctors
and hospitals will say, “Alrighty then,” and carry on providing the exact same services without any appreciable change to patients strains
credulity. For my practice, it would immediately put pressure on us to eliminate services we provide that do not
generate any revenue. As it stands, every patient of ours who gets admitted to the hospital is seen by one of our providers, even if they’re not admitted to
our service. We visit our patients in the hospital every day because we believe strongly that doing so keeps us informed about and involved in the management of our
patients’ care, even if we’re not ultimately in charge of that care at any given time. It generates no income for the practice when we do this, and it’s hard to see how
we could keep paying providers for this service when they could be in the office seeing patients instead. Further, every well-child exam at our practice is scheduled for
a full 30 minutes, and for medically complex patients we dedicate an entire hour. Giving ample time to discuss each patient’s care thoroughly, answer all the parents’
questions, and offer guidance about important health and safety issues is a value we hold strongly. But the pressure to maximize patient volume could put that value in
jeopardy. And despite pressure to see as many patients as possible, it’s still very likely that wewould need to reduce payroll costs to stay in
the black. Even if you factor in a reduction in our already-thin billing personnel (a prospect I don’t greet with any joy, as these are employees I care about), and
even with the substantial haircut my partners and I would doubtless take to support our staff as much as possible, we’d have to pay our providers
less. This may be a matter of blithe unconcern to advocates of Sanders’s plan, but it would almost certainly mean we’d have to make
compromises in what we ask our providers to do. We’re currently open seven days a week. Even on major holidays, we make a provider
available for urgent sick visits to the office. If you call our number outside regular office hours, at any time of the day, it’s one of our physicians or nurse practitioners
who gets the page. It’s hard to see us maintaining that level of availability while simultaneously cutting the pay of people who show up on Sundays and take those two
o’clock in the morning phone calls. Could we make all the changes necessary to make it worthwhile to stay in business? I hope so. It would be a grimmer place to
work, to be sure, but we’d try to make it happen. However, I have no doubt many offices would see the writing on the wall . Some
may try to sell to hospitals, which certainly won’t keep them open at a loss , and others will close
outright . Who will assume care for the thousands of patients these closures would displace is not a
question I see answered in Sanders’s plans. The government can provide insurance, but providing care directly is an even more ambitious change than
Sanders is already proposing. A phased-in approach to expanded Medicare enrollment, while allowing other payers to remain intact, would

obviously be far less disruptive. Gradual shifts in the multiple-payer system are much easier to
accommodate than a sudden large reduction in revenue. Given the choice between “adjust next year’s
budget” and “batten down the hatches,” I’d just as soon pick the former. But these incremental changes are not the revolution Sanders is
advocating. Fans of single-payer may well be willing to make sacrifices in terms of patient choice or provider availability. However, it does not withstand

scrutiny to say that hospitals and doctors will take a big decrease in compensation without patients feeling
the burn in a painful way. As with all things in medicine, a full discussion of risks and benefits must be had before a truly informed decision can be
made.

3. DISEASE – growth improves responses.

Hanna Samir Kassab 17. Visiting Assistant Professor of Political Science at Northern Michigan
University, Prioritization Theory and Defensive Foreign Policy. Springer International Publishing, 2017.
CrossRef, doi:10.1007/978-3-319-48018-3.
economies the world over are going through serious
The second vulnerability that must be prioritized is economic. As of writing (February 2016),

challenges. Decision-makers must create a more stable global market system that provides development and human security for all. Economic development
(discussed in the final part of this chapter) will allow states and decision-makers the ability to become more resilient to

other threats . Economic development is thus the second most important vulnerability to prioritize
because it instigates the best use of resources . By using resources efficiently, states can amass
capabilities to neutralize other sources of vulnerability such as health , military and political . To stem economic
vulnerability requires some protection from capitalism’s inherent flux: the cycles of boom and bust. The economy must be made to serve the community; it must be able to serve the needs of
society and therefore must be re-embedded: Our thesis is the idea of a self-adjusting market implied a stark utopia. Such an institution could not exist for any length of time without annihilating
the human and natural substance of society; it would have physically destroyed man and transformed his surroundings into a wilderness. Inevitably, society took measures to protect itself, but
whatever measures it took impaired the self-regulation of the market, disorganized industrial life, and thus endangered society in yet another way. (Polanyi 2001, 4) More regulation is therefore
needed to ensure the stability of world society, not just in terms of political stability but in environmental and other areas too. Allowing a totally liberal world economy is too risky given the
known costs. Proper mechanisms must be put into place to ensure sustainable growth rates to build resilience to systemic vulnerability and its reach or distribution across states. Decision-makers
must see this as important but certain industries continue to fight for deregulation. These industries are too greedy to be allowed into political discourse as they pervert the minds of decision-
makers (Stiglitz 2013). Greed works in the short term but it is ultimately short sighted: in the long run we are all dead after all. The other vulnerabilities are serious but are on their way to being
 States understand the power of Ebola, Zika and cyber-security, for instance, to destroy the world . States are well
stable.

down the road to developing infrastructure to absorb the chaos that can result from proliferation of such issues. This is
because decision-makers fully grasp the importance of establishing control over epidemics and cyber-insecurity.
Cyber-defensive measures are being bolstered and increasing power is being given to institutions and regimes to help fight and

neutralize outbreaks. More can be done but I am hopeful society is moving in the right direction here. Health invulnerability has a great deal to do with mental health. Many
terrorist movements take advantage of people who are clinically depressed due to their being ostracized from society. Mental health issues are part of overall health and must be treated like any
other disease. For this to occur, certain stigma must disappear in favor of treatment. In this way, environment and health protection can reduce recruitment to malicious organizations through
prevention. Military vulnerabilities coming from states and political vulnerabilities such as terrorist networks are the lowest priority. Strategies already exist to deal with these problems. We have
established that containment is the best form of engagement for both issues. If decision-makers perceive this as a viable option, then all that is missing is the will to implement the strategy. States
such as China, Russia and the USA position themselves aggressively; but war has not broken out yet because of diplomatic channels, as well as the presence of nuclear weapons that deter
aggression. Containment allows for a degree of understanding and freedom of state autonomy if certain lines are not crossed. As a consequence, state conflict is not a high priority at this juncture.
The same goes for violent political networks. These do not pose a serious challenge to any hegemonic state and are contained in specific areas of the world. Once we cut off access to wealth, then
groups like Islamic State are sure to fizzle out eventually if left alone to their own violent devices. The ranked order of vulnerabilities necessitates a fundamental shift of priorities, especially in
the realm of health and humanitarian focus. It will need serious cooperation at the global level. States must be made to work together on these matters. This is, therefore, a responsibility for great
powers and hegemonic actors, those who possess enough power to create and defend the system. These systems-creative actors (see Chap. 2) must guide this prioritization process by leading the
world against systems-destructive forces described. The capabilities of great powers must be used to solve systemic vulnerabilities. These interactions guide state behavior and are the defining
principle of any systemic theory of international politics. Given the multiplicity of systemic vulnerabilities and their distribution across units, states must further link respective resources. The
more resources available and in use, the more effectively states can solve problems. The use of securitization and prioritization discourse is essential to achieve this goal. It is here that we see the
application of the reprioritization process with regards to systemic vulnerabilities. Such action is a product of the securitization/desecuritization process of prioritization as vulnerabilities are

Decision-makers must not look at one source of vulnerability, but must rather
perceived as threatening to human survival.

take a structural approach to determine the most efficient way to deal with the wide array of problems that undermine survival. Hence, to recover well
during times of systemic crisis , whether financial, the result of the rapid influx of refugees or after natural disasters, is essential in dealing with sudden
and rapid systemic shocks . States that cannot deal with these on their own are considered weak and vulnerable . Great powers are those that are
economically developed with the resilience necessary to adapt quickly to any event. The root of success in neutralizing systemic vulnerability is through systems-creation, that is, the formation of

Economic development allows for the efficient use of scarce resources

an international system that supports economic development.

and is the key to resilience given systemic vulnerability. It allows a state the flexibility to absorb and defuse external shocks in all forms:
economic, political, environmental and so forth. Henry Bruton’s modernist definition of economic development understands states to be economically developed if they are sufficiently flexible
and diverse to adjust to change (Bruton 1965, 1). Development designates any increase in gross domestic product (GDP) that is sustainable, multidimensional and durable enough to endure
economic shocks. Undeveloped countries may suffer from productivity discrepancies due to sudden shock. For example, an undeveloped country would be a monocultural economy dependent on
one or two sources of wealth. Rapid fluctuations in commodity prices may send the country into macroeconomic chaos. A developed economy must be able to produce prosperity for the
population given potential instability. Conversely, an underdeveloped state is “low income … predominantly a primary producing and consuming area … production is food grains and fibers,
although in several countries mining is an activity of importance” (ibid., 88). Underdeveloped economies, then, possess vulnerabilities. Bruton notes this: “The rich country seems to have an
economy that has growth built into it, while the poor country seems to have an economy in which ‘nongrowth’ is built into it” (ibid., 2–3). Development specifically deals with eradicating

economic development presents a means to weather exogenous and

systemic issues that hamper growth (ibid., 3). Accordingly therefore, “

endogenous economic, environmental, political and social shocks endemic to vulnerable states … there is a clear
dichotomy between these two concepts, vulnerability and development” (Kassab 2014, 66). Economic development improves the resilience of states to recover from systemic shock. It allows for
best use of resources to counter threats and allows for the provision of human security, an important concept to stem the proliferation of violent political movements. Other vulnerabilities, such as
health, cyber, environmental, can also be dealt with given available resources. In the event of war, a developed state could very well outlast a lesser developed, revisionist state. Hence,

economic sustainability is the root of any state’s success in the face of systemic vulnerability .
 Econ ADV – Defense
Positive US economy predictions oppose recession warnings
Orla McCaffry 9/11 (bank reporter with experience at Wall Street Journal and a graduate of Craig
Newmark Graduate School of Journalism;9/11/23; “US will likely avert recession in 2024 bank
economists say”; https://www.americanbanker.com/news/u-s-will-likely-avert-recession-in-2024-bank-
economists-say#:~:text=Strong%20household%20spending%20and%20a,Association's%20Economic
%20Advisory%20Committee%20says.)
Resilient household spending and a strong labor market will likely help the U.S. economy avoid a severe
recession, according to a new forecast from economists at some of the country's biggest banks.
The economy is poised to grow at a rate of less than 1% through the second quarter of 2024, the
American Bankers Association's Economic Advisory Committee said Monday. That is low compared
with the second quarter rate of 4.1% but well above the dire predictions some economists once harbored
for 2024.
"The odds of a soft landing have improved quite dramatically in the near term," said Simona Mocuta,
chief economist at State Street Global Advisors and the chair of the ABA's committee of economic
advisors.
The specter of recession has weighed on banks for close to 18 months, since the Federal Reserve began its campaign of rate hikes in March 2022.
The health of the U.S. economy plays a key role in the profitability of banks, so the prospect of a contraction in economic growth raised red flags
for banks large and small. The likely avoidance of one of the harsher economic scenarios — a severe recession — is good news for banks, which
are also contending with generally tighter profit margins and increasing competition for customers.

Robust consumer spending has helped boost the U.S. economy so far in 2023, the ABA economists noted.
Low unemployment and strong wage gains mean households have been able to keep up with many of
their spending habits, even as inflation has persisted.
Inflation is also expected to improve in the coming quarters. Big-bank economists anticipate inflation
levels to continue to cool to an annualized rate of 2.2% by the second quarter of 2024, close to the central
bank's target rate of 2%.
Although the overall economic picture is brighter, economists warn that there are several lingering threats
that could make it more difficult for the U.S. economy and banks alike to grow.
The economists expect businesses to invest less capital in the short term, which could weigh on loan growth at banks. Loan growth at U.S.
commercial banks increased 4.5% in the second quarter from a year earlier, according to Federal Deposit Insurance Corp. data.

About 4.4% of the labor force will be unemployed by the end of 2024, according to the economists' forecast. A higher unemployment rate could
make it more difficult for laid-off workers to make loan payments, potentially boosting the level of charge-offs at banks.

Credit quality reached historic lows during the pandemic, when many creditors offered grace periods and other breaks to struggling borrowers
until the economy got back on track. Analysts expect asset quality to continue to deteriorate, with loan-loss increases spreading beyond the credit
card and commercial real estate arenas.

"Investors are eager to learn how much higher net charge-offs are expected to go, especially with the student loan moratorium coming to an end,"
Jason Goldberg, managing director and senior equity analyst at Barclays, wrote in a recent research note.

Certain elements of the ABA's advisory committee's forecast provide a strong contrast to the details
issued when the last forecast was issued earlier this year, when economists believed the U.S. was on the
edge of a mild recession.
"The tone of the conversation certainly feels much more positive today," Mocuta said.
Strong econ growth boosts forecasts
Bloomberg 9/7 (9/7/23; “Fed set to double its economic growth forecast after strong US economic
data”; https://economictimes.indiatimes.com/markets/stocks/news/fed-set-to-double-its-economic-
growth-forecast-after-strong-us-economic-data/articleshow/103447316.cms)
The US economy has been looking so solid lately that Federal Reserve officials will probably need to
double their projection for growth in 2023 when they publish an updated outlook later this month.

Following a string of stronger-than-expected reports on everything from consumer spending to residential

investment, economists have been boosting their forecasts for gross domestic product. One widely-
followed, unofficial estimate produced by the Atlanta Fed even has it expanding 5.6% on an annualized
basis in the third quarter.

That marks a sharp turnaround from three months ago - the last time policymakers updated their own
numbers - when the consensus view was that the economy would stall in the current quarter. And it may
be enough to prompt Fed officials to scale back their estimates for interest-rate cuts in 2024.

"Consumer spending was robust in June and July, so the third quarter is virtually baked in the cake at this
point," said Stephen Stanley, the chief economist at Santander Capital Markets US who is projecting
3.7% growth in the July-to-September period. "5% seems too high, but not impossible."

Any read on GDP growth above 3.2% would mark the strongest quarter since 2021, when the US was
experiencing a rapid recovery from the initial shock of the pandemic. The acceleration is in stark contrast
with the outlook for China, which has been downgraded in recent weeks amid a mounting property crisis.

When Fed officials last updated their own projections for the US in mid-June, they showed the median policymaker thought GDP would expand
just 1% in 2023. At the time, that marked an upgrade over the previous projection round in March, which implied a recession this year.

That number will probably go up to 1.8% or 2% in the new projections set to be released at the conclusion of the central bank's Sept. 19-20 policy
meeting, and the outlook for the unemployment rate could be revised lower, according to Omair Sharif, president of Inflation Insights LLC.

The growth upgrade may also lead Fed officials to scale back the easing they had projected for next year
to 75 basis points of rate cuts instead of 100, Sharif said.

BofA global research predicts US econ growth

Reuters 9/2/23 (“Bank of America Global Research raises US growth forecast on ‘soft landing’
expectation; https://www.reuters.com/world/us/bofa-global-research-raises-2023-us-gdp-growth-forecast-
soft-landing-expectation-2023-08-02/)
BofA Global Research on Wednesday forecast a "soft landing" for the U.S. economy andreces increased
its 2023 economic growth outlook for the country on the back of incoming data.
The brokerage no longer expects a mild recession in 2024 and sees real gross domestic product growing
2.0% on average this year, up from a previous forecast of 1.5%.
Data last week showed the U.S. economy grew faster than expected in the second quarter as a resilient
labor market supported consumer spending, while businesses boosted investment in equipment and built
more factories.
"Growth in economic activity over the past three quarters has averaged 2.3%, the unemployment rate has
remained near alltime lows, and wage and price pressures are moving in the right direction, albeit
gradually," BofA economists said.
Morgan Stanley recently raised its economic growth forecast on hopes of a "soft landing", where inflation
falls without a recession or big job losses, while Citigroup and Goldman Sachs increased their S&P 500
year-end target.
BofA now expects interest rate cuts by the U.S. Federal Reserve at a slower rate beginning in June,
followed by quarterly 25-basis point reductions for a total of 75 bps of rate cuts in 2024. The brokerage
sees 100 bps of cuts in 2025.

The fed is achieving a soft-landing now.

Rosen 9/8 – Phil Rosen earned his Master's of Science at the University of Southern California as an
Annenberg Fellow, and previously studied kinesiology and philosophy at San Diego State University, 9-
8-2023, Business Insider, "Recession outlook: Fed's own economists now expect Goldilocks scenario,",
https://www.businessinsider.com/fed-reserve-economists-goldilocks-recession-inflation-economy-
markets-powell-investors-2023-9?amp, Accessed 9-12-2023,dedeepya

The US economy may just skirt a recession after all and most of the effects of rate hikes have already taken shape,
according to Stefania D'Amico and Thomas King, economists at the Federal Reserve Bank of Chicago.

In a new September report, they argued that the 11 rate hikes since March of 2022 have put the economy on track for
a Goldilocks scenario of a soft landing , and there may no longer be a need for further monetary policy tightening .

D'Amico and King pointed to their vector autoregression model as reason to believe the Fed could hit its 2% inflation target by
next year. The 500 basis points of rate increases since last March have curtailed output, and prices are on a downward cooling
track .

"That model implies larger effects of monetary policy and faster policy transmission than other empirical
models," the economists said. "We estimate that although the majority of the effects on output and inflation have already occurred, the
policy tightening that has already been implemented will exert further restraint in the quarters ahead,
amounting to downward pressure of about 3 percentage points on the level of real gross domestic product ( GDP) and 2.5
percentage points on the Consumer Price Index ( CPI ) level."

Rate hikes are low now – unlikely to rise in the future

Saphir 8/10 – Ann Saphir is a reporter for Reuters and graduated from Harvard University with a BA
and from the University of California Los Angeles with an MPH, 8-10-23, Reuters, "Traders bet Fed rate
hikes are over, cuts to start in 2024," https://www.reuters.com/markets/rates-bonds/traders-bet-fed-rate-
hikes-are-over-cuts-start-2024-2023-08-10/, Accessed 9-12-2023, dedeepya

Aug 10 (Reuters) - Federal Reserve policymakers are unlikely to raise interest rates again in 2023 and will probably
start cutting them early next year, traders bet on Thursday, after a U.S. government report showed consumer prices rose only
moderately last month.

Traders of futures tied to the Fed's policy rate now see less than a 10% chance that the U.S. central bank will increase
its benchmark overnight interest rate from its current 5.25%-5.50% range at a Sept. 19-20 policy meeting.
They had seen about a 14% chance of a rate hike next month before the Labor Department report showed the July consumer price index (CPI)
rose 3.2% from a year ago, following a 3% year-over-year increase in June.

Traders are pricing in about a 28% chance of a rate hike by November, down from more than 30% before the release of the CPI report, with
higher rates by December seen as even less likely. The Fed's first rate cut is priced into the futures contracts by March of 2024.

The Fed has driven its policy rate up by 5.25 percentage points since March 2022 to bring inflation back down to its 2% goal.
Analysts said July's slight acceleration in year-over-year consumer price inflation - its first in 13 months - was a mathematical artifact of
the CPI's 40-year-high peak of 9% last year, and not an indication of worsening underlying trends .

"Assuming that the August print is somewhere in this vicinity ... I think this largely terminates the rate-hike cycle ," said Guy
Lebas, chief fixed income strategist at Janney Montgomery Scott. "There's always a chance we get reacceleration of inflation prints after October,
but I don't think that's going to spur Fed action."

a. THE INFLATION REDUCTION ACT – it’s lowering drug prices.

CMS, 3-15-2023, Government agency, "Inflation Reduction Act Tamps Down on Prescription Drug
Price Increases Above Inflation," Centers for Medicare & Medicaid Services,
https://www.cms.gov/newsroom/press-releases/inflation-reduction-act-tamps-down-prescription-drug-
price-increases-above-inflation, AJ
The Biden-Harris Administration has made lowering prescription drug costs in America a key priority —
and President Biden is delivering results. Today, the Department of Health and Human Services, through the Centers for Medicare
& Medicaid Services (CMS), announced 20 prescription drugs for which Part B beneficiary coinsurances may be lower from April 1 – June 30,
2023. Thanks to President Biden’s new law to lower prescription drug costs, some people with Medicare who take these drugs may save between
$1 and $372 per average dose starting April 1, depending on their individual coverage. Through
the Inflation Reduction Act,
President Biden and his Administration are lowering prescription drug costs for American seniors and
families.
“The Biden-Harris Administration believes people with Medicare shouldn’t be on the hook when drug companies inexplicably jack up the prices
of their drugs,” said HHS Secretary Xavier Becerra. “President Biden made lowering prescription drug costs for Americans a top priority and
we’re using every lever we have to deliver results. With the inflation rebate program, we are fighting to ensure seniors can afford the treatments
they need, taxpayers aren’t subsidizing drug company excess prices, and the Medicare program is strong for millions of beneficiaries now and in
the future.”

The Medicare Prescription Drug Inflation Rebate Program is one of the many important tools Medicare
has to address rising drug costs. By reducing coinsurance for some people with Part B coverage and discouraging drug companies
from increasing prices faster than inflation, this policy may lower out-of-pocket costs for some people with Medicare and reduce Medicare
program spending for costly drugs.

“The Medicare Prescription Drug Inflation Rebate Program is a critical way to address long-term price
increases by drug companies while improving access and affordability for the millions of people with
Medicare coverage,” said CMS Administrator Chiquita Brooks-LaSure. “Continued implementation of the new drug law
strengthens Medicare, faithfully guards taxpayer dollars, and improves the long-term sustainability of the
program for generations to come.”
CMS has released information about these 20 Part B drugs and biological products in the quarterly ASP public file, available here. A fact sheet is
available here.

Lower Part B coinsurance will go into effect on April 1, 2023. This coinsurance adjustment applies to certain drugs and biologicals covered under
Medicare Part B. The Part B drugs impacted by this coinsurance adjustment may change quarterly.

See the initial guidance detailing the requirements and procedures for the Medicare Prescription Drug Inflation Rebate Program here.

In addition, HHS released a report on how much Medicare Part D enrollees would have saved on vaccine cost-sharing if the Inflation Reduction
Act had been in effect in 2021.

Their economics are wrong --- underestimate costs, insufficient incentives, brain
drain, waiting time, and empirics.
Ohanian 19 — Professor of Economics and Director of the Ettinger Family Program in
Macroeconomic Research at the University of California, Los Angeles, Associate Director of the Center
for the Advanced Study in Economic Efficiency at Arizona State University, PhD in Economics from the
University of Rochester, 2019 (“The Extremely Bad Economics Of Single-Payer Healthcare For
California,” Hoover Institute, 04-16-2019, Available Online at
https://www.hoover.org/research/extremely-bad-economics-single-payer-healthcare-california, Accessed
on 05-20-2023)

The cost estimate is also understated , because such a plan would draw in new residents from other
countries and other states who may have very expensive conditions . This could easily increase costs
by 5 percent or more , for an additional $20 billion .

Any sensible reform of US healthcare must confront the problem that the consumers of healthcare do not
have sufficient incentives to control costs . A California single-payer plan doubles down on this issue
because it would eliminate virtually all incentives for consumers to control costs. No co-pays and no
deductibles mean increased demand for virtually all healthcare , and extraordinary rationing of
healthcare.

Ironically, one of the main sales pitches for single-payer healthcare—“You can’t be denied”—is false .
Current and future procedures that are deemed by those running the state’s health board to be “too
expensive” will indeed be denied or severely rationed . And you may need to wait in line a long time
before receiving healthcare. The healthcare market does not magically avoid the economic realities of
all other markets. If society provides a good at zero cost to the consumer, then the good will be allocated
by rationing rather than price. No ifs, ands, or buts.
If you think that the only restricted procedures will be extremely expensive, experimental procedures,
then you need to think again. Britain has one of the oldest continuously operating nationalized healthcare
systems, the National Health Service (NHS), and is now restricting one of the most common eye
surgeries, cataract operations, because the NHS believes them to be of “limited clinical value.” Really?
More broadly, recent statistics from Britain showcase just how significant these problems are in
practice, and just how poorly the UK healthcare system functions. Data from the NHS shows that nearly a
quarter of a million British patients have been waiting more than six months to receive medical treatment.
And don’t think that grossly unreasonable waits only affect elective procedures. Only 84 percent of
patients in British hospital emergency rooms are seen within four hours following admission. The
country’s goal is to see 95 percent of patients within four hours, which is a goal that has not been
achieved since 2015. It is now so obvious that the goal cannot be realistically met that the United
Kingdom is considering to eliminate the goal.
Young doctors in Britain, who make up nearly half of British physicians, are so fed up with working
conditions that they are threatening to go on strike. Physicians in the United Kingdom complain that
patient overcrowding within the system is tantamount to “ third-world medical conditions ” and
remark that it is similar to “ battlefield medicine .”

Not surprisingly, some doctors who are being trained in England are choosing to practice medicine in
other countries rather than facing the alternative of dealing with the remarkably deficient National
Health Service.

UK physician brain drain has been going on as long as the existence of their national healthcare
system. This has now become so extreme that 35 percent of existing British doctors are imported from
other countries , most from very poor countries.

Staffing problems, which are obviously critical now , will become extreme in another decade. A recent
report forecasts a shortfall of 250,000 medical staff by 2030. And keep in mind that predictions such as
these are almost always too optimistic .

This means that the current completely unacceptable waiting times for treatment will increase , and
increase considerably . According to January NHS England data, almost 25% of cancer patients didn't
start treatment on time despite an urgent referral by their primary-care doctor. If you are wondering what
“on time” means, then think of how airlines pad travel times. For the NHS, “on time” already means 62
days after referral.

Sadly, waiting times do matter . Only 81% of UK breast cancer patients survive at least five years after
diagnosis, compared to 89% in the United States, and just 83% of patients in the United Kingdom live
five years after a prostate cancer diagnosis, compared to 97% in the United States.
For anyone thinking about how to reform health care—irrespective of your politics—think of all of the
thousands of commodities and services that you and your family privately purchase within the
marketplace. In how many of those markets are you restricted or denied the opportunity to make these
purchases? How often do you need to wait six months to obtain the good or service that you would like to
purchase? How often do you see the suppliers of the goods and services that you buy bailing en masse on
the United States, moving to another country to set out their shingle and start over?

Roughly never. Ever. Why never? Because markets work . It is that simple. The statistics summarized
here from the United Kingdom are chilling. They should not be repeated in California or anywhere else.
There are infinitely better ways to reform US healthcare. I’ll discuss those in a forthcoming COYM
column.
 1. Healthcare and social security costs and suspending are sustainable.
Krugman 23 — Paul Krugman, Professor Emeritus of Economics at Princeton University, former
Professor of Economics at the Massachusetts Institute of Technology, Distinguished Professor of
Economics at the Graduate Center of the City University of New York, PhD in Economics from the
Massachusetts Institute of Technology, 2023 (“Why Medicare and Social Security Are Sustainable,” The
New York Times, 02-21-2023, Available Online at
https://www.nytimes.com/2023/02/21/opinion/medicare-social-security.html, Accessed on 05-29-2023)
The press’s response to Biden’s remarks has, however, been less gratifying. I’ve seen numerous
declarations from mainstream media that of course Medicare and Social Security can’t be sustained in
their present form. And not just in the opinion pages: There’s been at least some reversion to the early
2010s practice of including anti-social-insurance editorializing in what are supposed to be straight news
reports, with highly disputable claim s about these programs’ futures presented as simple facts .

So let me try to set the record straight. Yes, our major social programs are on a trajectory that will cause
them to cost more in the future than they do today. But how we deal with that trajectory is a choice, and
the solution need not involve benefit cuts.
A good starting point on all these issues is the Congressional Budget Office report on the long-term
budget outlook — a report issued every year, with the most recent report released in July. (The numbers
were updated this month, but the basic picture hasn’t changed.) The C.B.O. does excellent work, without
a policy agenda, and is an extremely useful resource.
The current report offers a very clear depiction of both the budget challenges facing our major social
insurance programs and the sources of those challenges. Here’s my favorite figure, showing projected
changes in spending over the next 30 years:

But the budget office is not necessarily always righ t — in fact, the ways in which it has proved wrong
in the past are highly illuminatin g. To put this chart in context, there’s a widespread narrative to the
effect that Medicare and Social Security are unsustainable because they won’t be able to handle the mass
retirement of baby boomers. But as you can see right away, only about half the projected rise in spending
is the result of population aging . The rest comes from the assumption — and that’s all it is, an
assumption — that medical costs will rise faster than gross domestic product .
Before I get there, a word about demography. You might think that the projected aging is all about the
baby boomers. But the baby boom is generally considered to have ended in 1964. So the last of us — yes,
I’m one of them — will hit 65 in 2029, just six years from now. Most baby boomers are already there.
So why does the C.B.O. project continuing budget pressure from aging? Because it assumes that life
expectancy, specifically life expectancy at age 65, will keep rising. That has certainly been true in the
past, but given America’s mortality problems , I’m not sure that it’s safe to assume this trend will
continue at past rates.
Still, let’s grant the aging bit. What about “additional cost growth” in health care?
Well, historically health spending has risen faster than G.D.P. — largely, we think, because doctors can
now treat many more things than in the past, and this effect has outpaced cost savings from improved
technology. But excess cost growth has slowed considerably since around 2010 — perhaps in part
because of cost-reduction aspects of the Affordable Care Act. In any case, the leveling off is
unmistakable. Here’s national health spending as a percent of G.D.P.:

This health-cost slowdown has, as it should, affected budget projections. Back during the early 2010s, the
heyday of the Very Serious People who insisted that Medicare and Social Security were unsustainable,
C.B.O. projections assumed that health spending would grow at historical rates. This meant that under
current policies long-run projected spending was indeed enormous, and obviously unsustainable.

But that has changed, a lot . I don’t know if people still repeating the old slogans about the need for
entitlement reform realize just how much projections of future spending have come down . But here’s a
comparison between projected Medicare spending as a percent of G.D.P. from the 2009 long-term budget
outlook and the most recent projection:
A side note: The C.B.O. used to do 75-year projections, but apparently realized at some point that these
are of little value, because nobody has any idea what the world may look like in 75 years. I used to joke
that long before we got there, Skynet would have killed us all, but now we know better: Bing’s chatbot
will do us in. In any case, the projections now go only 30 years ahead.
Anyway, C.B.O. projections now show social insurance spending as a percentage of G.D.P. eventually
rising by about 5 points, which is still a lot but not unimaginably large . And here’s the thing: Half of
that is still the assumed rise in health care costs. And there are things we can do to control costs that
don’t involve cutting off Americans’ benefits. Bear in mind both that U.S. health care is far more
expensive than that of any other nation — without delivering better results — and that since 2010 we’ve
already done quite a lot to “bend the curve.” It’s not at all hard to imagine that improving the
incentives to focus on medically effective care could limit cost growth to well below what the C.B.O. is
projecting, even now .

And if we can do that, the rise in entitlement spending over the next three decades might be more like 3
percent of G.D.P. That’s not an inconceivable burden . America has the lowest taxes of any advanced
nation; given the political will, of course we could come up with 3 percent more of G.D.P. in revenue.

So no , Social Security and Medicare aren’t inherently unsustainable , doomed by demography. We

can keep these programs , which are so deeply embedded in American society, if we want to. Killing
them would be a choice.

a. LABOR-PRICES.
Waikar 19 [Sachin Waikar is a freelance writer citing research by Jillian Chown (Associate Professor of Management &
Organizations), David Dranove (Walter J. McNerney Professor of Health Industry Management; Faculty Director of PhD
Program; Professor of Strategy), Craig Garthwaite (Professor of Strategy; Herman Smith Research Professor in Hospital and
Health Services Management; Director of Healthcare at Kellogg); “Would “Medicare for All” Really Reduce Healthcare Costs in
the U.S.?”; Kellogg Insight; October 4, 2019; https://insight.kellogg.northwestern.edu/article/medicare-for-all-reduce-healthcare-
costs-prescription-drugs]//eleanor

How “Medicare for All” Would Affect Prices in America

Overall, the findings imply that a U.S. single-payer system may not drive as much cost savings as
politicians and other advocates suggest, given that the price of labor —which makes up more than half
of all health spending —would be difficult to tamp down without causing shortages .

Meanwhile, if the U.S. put major downward pressure on drug prices, it could compromise long-term
health outcomes by reshaping the drug market.
“‘Medicare for All’ might be a workable way to expand health-insurance coverage,” Dranove says, “but if
we expect it to dramatically cut into health spending without also affecting quality, we may be
disappointed.”
“It’s a question of what you’re trying to optimize,” Garthwaite adds. “People have to understand there’s
no free lunch here.”

b. CORPORATE CAPTURE.
Phillip Longman 18, PHILLIP LONGMAN is a senior editor at the Washington Monthly and the
program director at the Open Markets Institute. He is the author of Best Care Anywhere: Why VA Care
Would Work Better for Everyone, 3rd edition, 2011., 1-2-2018, "Why Universal Health Care Needs
Antitrust," Democracy Journal, https://democracyjournal.org/arguments/why-universal-health-care-needs-
antitrust/
Much public attention focused, in December, on whether Republicans would at last succeed in repealing key provisions of Obamacare. But while
protestors raged in front of congressional offices, the most consequential decisions over the future of American health care were being quietly
decided elsewhere, specifically in the board rooms of giant corporations. Recent years have seen record levels of mergers and acquisitions in the
health-care sector, to be sure. But of
late the deal-making has reached a whole new level in both quantity and kind.
Just the first six months of 2017 saw 58 major mergers among hospitals and health-care systems, with six of those involving
corporations boasting $1 billion or more in revenue. Then in December came a new wave of consolidations that augers vast changes in the
structure and balance of power within the sector. In human terms, everything about how you experience the health-care system, from your choice
of doctor to how much you pay to whom, is now in play. The month began with the announcement that the giant drugstore chain CVS was buying
up the giant health insurer Aetna for $69 billion. The resulting entity would be at once a retailer, a pharmacy, a pharmacy benefit manager, and an
insurer, while also operating an expanding base of clinics. A few days later, UnitedHealth Group announced that it too was expanding control up
and down the health-care supply chain. No longer content to be merely the country’s largest health insurer, it is now in the business of practicing
medicine as well after swooping up nearly 300 doctors’ clinics run by the DaVita Medical Group chain. Then came word that two major hospital
systems are negotiating a deal that would create the largest hospital chain the United States has ever seen. The merger of Ascension and
Providence St. Joseph Health would create an entity controlling 191 hospitals in 27 states with an annual revenue of $44.8 billion. Mergers
beget mergers. Lurking behind these combines is a fear of being gobbled up not only by the giants
emerging from the last round of mergers, but of a still larger goliath . Amazon has shown abundant
signs that it is preparing to use its unprecedented market power to dominate medical supplies and
pharmaceuticals. And if Amazon becomes the world’s largest pharmacy, what would stop it from
expanding vertically by offering loss leading discounts to drive out all rivals as it has in so many
other sectors? If you bought discounted Amazon prime health insurance you could buy discounted
Amazon drugs prescribed by discounted Amazon doctors and dispensed by discounted Amazon nurses,
who might also refer you to Amazon’s recently acquired Whole Foods for discounts on organic
vegetables grown on Amazon plantations. Could that be in the public interest? In health care, as
elsewhere, deal makers always try to sell mergers with promises of increased efficiency . And when it
comes to health care, there is certainly plenty of waste, as well as all kinds of harms done to patients by
lack of care coordination and, let’s be frank, by price gouging . But will creating new giant monopolies
fix that? There’s a story you can spin . The combine of CVS and Aetna, for example, could have far greater bargaining power in
negotiating with drug manufactures for lower prices. It might also gain efficiency by driving so-called Pharmacy Benefit Managers out of the
supply chain. These middlemen are widely seen as driving up drug prices. It’s also at least theoretically possible that the combine’s vertical
integration could bring some clinical benefits. It might do so, for example, by taking a more active interest in whether patients were prescribed
appropriate drugs and stayed on their medications. But these possible benefits are far-fetched . Other vertical mergers
in health care, such as between hospitals and doctors’ practices, have sometimes brought efficiency gains and less fragmented
care, but the benefits are rarely shared with consumers . Indeed, because of the resulting increase in
monopoly power, these mergers have generally brought higher prices and more political control over
regulators . A vertical merger between a payer and provider is potentially even more problematic. The
CVS/Aetna combine for example would forestall competition both from other insurers and from
other drug retailers , and thereby lead to less competitive markets in the not-so-long term. New insurers
would be unlikely to enter the market because they would lack the market power and data needed to
compete with the CVS/Aetna combine in negotiating with drug companies. Meanwhile, other retailers wouldn’t be able
compete with an entity that is using its own insurance company to drive customers to its stores. So, while
some mergers may bring greater efficiency, there is no reason to believe that the saving will be shared
with health-care consumers. Meanwhile, the loss of competition will, over time, lead to higher prices
and a reduced incentive into innovate . Some might imagine that moving to a single-payer system would solve the problem of
monopolization in health care. If under a “Medicare for All” plan the government was the sole purchaser of health
care, wouldn’t it have the market power to dictate prices to health-care providers? It would in the
absence of monopoly . But what happens when single payer meets single provider? Already, in vast
regions of the country, a single integrated system monopolizes nearly all as aspects of health care, from
doctors’ practices to labs, clinics, and hospitals. As I’ve written elsewhere, if the Department of Health and Human Services
tried to contract with the Cleveland Clinic or the Pittsburgh University Medical Center to provided medical services under a single-payer plan, it
would have no more market power than our “single-payer” Pentagon procurement system does when it
comes to bargaining with sole-source defense contractors. And we know how that goes. Of course, the
government could in theory just set the price it’s willing to pay for the next generation of fighter jets or
aircraft carriers and refuse to budge. But in practice , a highly consolidated military-industrial complex
has enough economic and political muscle to ensure not only that it is paid well , but also that Congress
appropriates money for weapons systems the Pentagon doesn’t even want. And so it would be with
regard to the health-care industry.

Turns both advantages---spends a ton of money while still limiting quality and access
Phillip Longman 16, policy director at New America’s Open Market program, Fall, "Time to Fight
Health-Care Monopolization," Democracy Journal, https://democracyjournal.org/magazine/42/time-to-
fight-health-care-monopolization/
What’s to be done? A single-payer, “Medicare for all” approach won’t work if all it is doing is
distributing subsidies to monopolists. Under a single-payer system, the federal government would have the ability, at least in theory, to set prices
throughout the U.S. health-care system by turning the dial up or down on the amount of subsidies it paid to providers. But it is naive to expect
that government regulators won’t become even more captured than they already are if economic, and
therefore, political power becomes ever more concentrated in the industry they are supposed to regulate .
Already, the federal government allows a committee of the American Medical Association to
effectively determine what prices it pays Medicare providers . More concretely, if the trend toward
monopoly in health care continues, Americans won’t enjoy anything like the choice of doctors and
hospitals that today’s Medicare beneficiaries do. And in the absence of any real competition within the
system, one can expect declining quality and service levels as well, just as occurs wherever
monopolies take hold.
Means they solve nothing---would try to set priorities but turn out stupid.
Silvio Garattini & Vittorio Bertele 18. Directorate, IRCCS Istituto di Ricerche Farmacologiche Mario
Negri, Via Giuseppe La Masa. 2018. “Myth #6: Health Care Is Rightly Controlled by the Public Sector,
for the Sake of Equality.” The Myths of Health Care, edited by Paola Adinolfi and Elio Borgonovi,
Springer International Publishing, pp. 155–176. CrossRef, doi:10.1007/978-3-319-53600-2_9.
9.3.2 Public Health Authorities Do not Set Priorities Public health authorities should first identify the unmet needs of the population and set
priorities according to criteria not only of equality but also of solidarity. This means, for instance, looking at emergencies arising in society, such
as diabetes or senile dementia in Western countries. But they must also consider neglected diseases, such as the 6–7000 rare diseases that affect
more than 30–40 million people in the European Union, though each one affects no more than 1 in 2000 inhabitants. Instead, it
is the
private sector which establishes what people mostly need. Privately owned businesses follow
commercial criteria together with marketing opportunities which satisfy their stockholders’ wishes, not
necessarily people’s health priorities. Private hospitals often select remunerative pathologies and interventions (obesity,
plastic surgery, etc.) but pay little attention to multiple chronic diseases in the elderly or expensive and risky emergency
interventions. Industry prefers to invest in R&D on products (diagnostics, medical devices, and medicines) that people
want or attract professionals’ interest, though most often meeting secondary needs. It is surprising that
among the pharmaceutical blockbusters of the last decade there are drugs addressing erectile
dysfunction , which may be a cure for a minority but are a plaything for the majority . It is the latter
that ensures a return on investments . When a no profitable pathology such as the one mentioned can be
identified, the industry invents diseases and leads people to believe that they need interventions. This
strategy is called “ disease-mongering ,” which essentially involves trying to convince healthy people
that they are sick , and mildly sick people that they are very ill (Moynihan et al. 2002). Examples include the
so-called chronic fatigue syndrome, restless leg syndrome, fibromyalgia, motivational deficiency
disorders, and so on. This strategy also involves lowering the thresholds that define disease status or
risk factors (blood pressure, hyperglycemia, or hypercholesterolemia, etc.). All of a sudden, many previously healthy
people become sick and need intervention. All this is a consequence of a lack of strategy in the public
sector, which ceases to drive the process . Identification and selection of health priorities would educate the public, and at the
same time would satisfy its real needs. People would not be abandoned to a marketing pressure that tries to convince them they have needs in
addition to or in place of the ones they actually have, as happens with any commercial goods.

1. MEDICARE. Single-payer decks business confidence – ruins the stock

market and decks investor profits.
Summers ’19 [Lawrence H.; 11-05-2019; “Warren’s plan to finance Medicare-for-all pushes into
dangerous and uncharted territory”; The Washington Post; Former United States Secretary of the
Treasury; https://www.washingtonpost.com/opinions/2019/11/05/warrens-plan-finance-medicare-for-all-
pushes-into-dangerous-uncharted-territory/ \\pairie]

Third, the combined tax impact of Warren’s various plans is extreme. While the case for more tax progressivity is
compelling, and each of the Warren measures can be defended in isolation, there is the concern that their cumulative impact may be excessive
The total after-
should, as the Warren campaign repeatedly claims, they be borne only by the very wealthy. Here is a suggestive comparison:
tax adjusted gross income of all those earning more than $1 million or more, as last reported by the IRS in its
Statistics of Income publication, was under $1.1 trillion . The sum of all the new taxes on the wealthy proposed by Warren is of
comparable magnitude: adding together around $310 billion a year in new wealth taxes; $330 billion a year in corporate taxes from her new
proposals and her previous real corporate profits taxes; $240 billion a year from her new capital gains and finance tax proposals; at least $90
billion from her across-the-board 14.8 percent taxes of labor and investment income; and $190 billion in increased compliance. This totals nearly
$1.2 trillion — more than millionaires’ total after-tax income.

Of course, this calculation is an oversimplification. Different taxpayers are situated differently and will be affected differently by any set of
proposals. There will be tax collections from those who are not middle class but still earn less than $1 million a year. There are sources of
“income” that will be taxed under the Medicare-for-all proposal that do not show up in current adjusted gross income — unrealized capital gains
or corporate retained earnings, for example. On the other hand, it’s
highly problematic given the avoidance and other bad
incentives likely to result, to be anywhere in the ballpark of confiscatory taxation of high-income
taxpayers.
Finally, what of the economic and financial effects of Warren’s proposals? A place to start is by thinking
about the potential impact on the stock market . The market is valued as investors’ claim on future
corporate earnings, which the Bureau of Economic Analysis estimates are about $1.8 trillion this year. As a result of all the tax
claims just described, the Warren program would reduce investors’ claim on these earnings. Recognizing
that some of these taxes fall on salary income or non-corporate business, it is reasonable to estimate that investors will pay an
extra $500 billion to $600 billion in taxes related to corporate profits. Then, Medicare-for-all proponents cite a
severe hit to health industry profits, currently on track to be over $200 billion this year. Then, there will be
the broader impacts of overhauling regulation , often to serve vital social interests, in initiatives such
as banning fracking and reforming the energy industry, stepping up financial regulation, a major increase
in antitrust enforcement and the regulation of technology companies, and filling corporate board seats
with labor representatives. It is hard to see an argument that investors’ claim on profits would fall less than a third.
The figure could be considerably greater.

Because of abnormally high valuations, along with increased uncertainty and volatility, loss of business
confidence and selling pressure from those in distress, the market would likely fall more than
proportionally to earnings. Accurate market predictions are impossible and will in any event depend not on what is proposed but on
what the market expects will actually take place. There is, however, the real risk of economic contraction following a sharp
market decline, especially given that the current very low level of interest rates puts the Fed in a weak
position to pursue counter-cyclical policy .

Single Payer destroys the economy – massive tax hikes and decreases overall GDP
by 9.5%
Tanner 6/23/17 – senior fellow at the Cato Institute (Michael, “What Americans really want from
health care reform is impossible,” http://nypost.com/2017/06/23/what-americans-really-want-from-health-
care-reform-is-impossible/)
It is an old joke among health policy wonks that what the American people really want from health care
reform is unlimited care, from the doctor of their choice, with no wait, free of charge.
For Republicans, trying to square this circle has led to panic, paralysis, and half-baked policy proposals
such as the ObamaCare replacement bill. For Democrats, it has led from simple disasters such as
ObamaCare itself to a position somewhere between fantasy and delusion.
The latest effort to fix health care with fairy dust comes from California, whose Senate voted to establish
a statewide single-payer system. As ambitious as the California legislation is, encompassing everything
from routine checkups to dental and nursing home care, its authors haven’t yet figured out how it will be
paid for. The plan includes no co-pays, premiums or deductibles. Perhaps that’s because the legislature’s
own estimates suggest it would cost at least $400 billion, more than the state’s entire present-day budget.
In fairness, legislators hope to recoup about half that amount from the federal government and the
elimination of existing state and local health programs. But even so, the plan would necessitate a $200
billion tax hike. One suggestion being bandied about is a 15 percent state payroll tax. Ouch.
The cost of California’s plan is right in line with that of other recent single-payer proposals. For example,
last fall, Colorado voters rejected a proposal to establish a single-payer system in that state that was
projected to cost more than $64 billion per year by 2028. Voters apparently took note of the fact that,
even after figuring in savings from existing programs, possible federal funding, and a new 10 percent
payroll tax, the plan would have still run a $12 billion deficit within 10 years.
Similarly, last year Vermont was forced to abandon its efforts to set up a single-payer system after it
couldn’t find a way to pay for the plan’s nearly $4 trillion price tag. The state had considered a number of
financing mechanisms, including an 11.5 percent payroll tax and an income tax hike (disguised as a
premium) to 9.5 percent.
On the national level, who could forget Bernie Sanders’ proposed “Medicare for All” system, which
would have cost $13.8 trillion over its first decade of operation? Bernie would have paid for his plan by
increasing the top US income-tax rate to an astounding 52 percent, raising everyone else’s income taxes
by 2.2 percentage points, and raising payroll taxes by 6.2 points.
Of course, it is no surprise that Medicare for All would be so expensive, since our current Medicare
program is running $58 trillion in the red going forward. It turns out that “free” health care isn’t really
free at all.
How, though, could a single-payer system possibly cost so much? Aren’t we constantly told that other
countries spend far less than we do on health care?
It is true that the US spends nearly a third more on health care than the second-highest-spending
developed country (Sweden), both in per-capita dollars and as a percentage of GDP. But that reduction in
spending can come with a price of its own: The most effective way to hold down health care costs is to
limit the availability of care. Some other developed countries ration care directly. Some spend less on
facilities, technology or physician incomes, leading to long waits for care.
Such trade-offs are not inherently bad, and not all health care is of equal value, though that would seem to
be a determination most appropriately made by patients rather than the government. But the fact remains
that no health care system anywhere in the world provides everyone with unlimited care.
Moreover, foreign health care systems rely heavily on the US system to drive medical innovation and
technology. There’s a reason why more than half of all new drugs are patented in the United States, and
why 80 percent of non-pharmaceutical medical breakthroughs, from transplants to MRIs, were introduced
first here. If the US were to reduce its investment in such innovation in order to bring costs into line with
international norms, would other countries pick up the slack, or would the next revolutionary cancer drug
simply never be developed? In the end, there is still no free lunch.
American single-payer advocates simply ignore these trade-offs. They know that their fellow citizens
instinctively resist rationing imposed from outside, so they promise “unlimited” care for all, which is
about as realistic as promising personal unicorns for all.
In the process, they also ignore the fact that many of the systems they admire are neither single-payer nor
free to patients. Above and beyond the exorbitant taxes that must almost always be levied to fund their
single-payer schemes, many of these countries impose other costs on patients. There are frequently co-
payments, deductibles and other cost-sharing requirements. In fact, in countries such as Australia,
Germany, Japan, the Netherlands and Switzerland, consumers cover a greater portion of health care
spending out-of-pocket than do Americans. But American single-payer proposals eliminate most or all
such cost-sharing.

Adopting a single-payer system would crush the American economy, lowering wages, destroying
jobs and throwing millions into poverty . The Tax Foundation, for instance, estimated that Sanders’
plan would have reduced the US GDP by 9.5 percent and after-tax income for all Americans by an
average of 12.8 percent in the long run . That is, simply put, not going to happen. So Americans are
likely to end up with a lot less health care than they have been promised.
Santa Claus will always be more popular than the Grinch. But the health care debate needs a bit more
Grinch and a lot less Santa Claus. Americans cannot have unlimited care, from the doctor of their choice,
with no wait, for free. The politician who tells them as much will not be popular. But he or she may save
them from something that will much more likely resemble a nightmare than a utopian dream.

Costs more than its worth – massive tax increases reduce spending, wages, and
employment.
Haislmaier & Hall, 19 [Edmund Haislmaier, Jr. Senior Research Fellow, Center for Health and
Welfare Policy; Jamie Hall, Research Fellow, Quantitative Analysis, Center for Health and Welfare
Policy; 11-19-19, ‘How “Medicare for All” Harms Working Americans’,
https://www.heritage.org/health-care-reform/report/how-medicare-all-harms-working-americans //alundy]
Advocates of this idea suggest that Americans currently covered by private health plans would be financially better off, even
after their taxes are raised to fund the proposed new government program. For example, Senator Bernie Sanders (I–VT) has said: “Are
people going to pay more in taxes? Yes. But at the end of the day, the overwhelming majority of people are going to end up paying less for health
care because they aren’t paying premiums, co-payments or deductibles.”2

That assertion is incorrect . Our analysis finds that in order to fund such a program, it would be necessary for
the federal government to impose substantial, broad-based taxes equal to 21.2 percent of all wage and
salary income. Those taxes would be in addition to the payroll taxes that most workers already pay for the existing Social
Security and Medicare programs, bringing total payroll taxes to 36.5 percent for most workers.3
No proponent of this idea has provided a complete plan to pay for this proposal. Senator Sanders and Senator
Warren have each offered plans to partially fund Medicare for All through combinations of payroll taxes imposed on
employers and increased income taxes. We have chosen to model the full tax burden to pay for Medicare for All , and we
used a higher payroll tax rate on employees because it is the standard measure for projecting the tax
burden of a social insurance program. Moreover, this approach avoids the significant behavioral response
effects of other possible tax increases. Additionally, the Committee for a Responsible Federal Budget (CRFB)
recently provided several pay-for options. The CRFB highlights a 32 percent payroll tax split evenly between the employer and
the employee, and notes that it would raise the same revenue as a 23 percent payroll tax paid solely by the employee. That latter figure is very
similar to what we derived (21.2 percent). We modelled a payroll
tax paid solely by the employees because imposing a
tax on employers (all or in part) would produce additional adverse effects on cash compensation,
employment, and business profitability—particularly for employers with workers near the statutory minimum wage, whose hourly
wage cannot be reduced to offset the cost of the new tax.
The resulting smaller tax base would, in turn, necessitate even
higher tax rates to collect the same amount of revenue.
We also find that nearly two-thirds
of American households (65.5 percent, comprising 73.5 percent of the population) would
experience reductions in their disposable income , making them financially worse off. Those households would pay
more in new taxes to fund the program than they would save as a result of the program eliminating
their current spending on private health insurance and out-of-pocket medical expenses.
average
After accounting for both the tax increases and the reductions in private spending for health insurance and medical care, we find that
annual household disposable income would decline by $5,671 (or 11 percent ) under a new government-run
health care program.
Among households with employer-sponsored health benefits, 87.2 percent would be worse off financially
under a new government-run health care program, and their annual disposable income would be $10,554 lower, on average.
That would occur despite those households receiving wage increases, as employers responded to the new program by
converting the value of current tax-free, employer-provided health benefits into additional taxable cash income.4

We assume that, should Medicare for All legislation pass, employers will convert funds they spend on health benefits
today into higher wages. Appendix A includes a more detailed discussion of this assumption and resulting changes to the tax base.

The reason: Workers would pay much higher taxes to fund the cost of the new program because workers
would need to (1) replace their own private spending, (2) replace non-workers’ private spending, and (3) pay
for the additional spending that would result from the program stimulating increased use of medical care.

Even with the aff’s ‘savings’, it still costs too much.

Holahan & Blumberg, 18 [John Holahan, institute fellow in the Health Policy Center at the Urban,
Linda Blumberg, institute fellow in the Health Policy Center at the Urban, 10-2018, ‘Estimating the Cost
of a Single-payer Plan’, institute,https://www.urban.org/sites/default/files/publication/99151/
estimating_the_cost_of_a_single-payer_plan_0.pdf //alundy]
The Urban Institute team’s
Because of the research teams’ different assumptions, the two sets of findings are not directly comparable.
10-year estimate of the increase in federal spending would be higher, closer to $40 trillion , if we had estimated
program costs over the same period as the Mercatus Center. The additional federal costs would be $2.9 trillion lower ($3.6
trillion lower using the later budget window) if we had not assumed expansion of long-term care services. These two
adjustments would move the Urban Institute estimates of a 10-year increase in federal costs to roughly $36 trillion
dollars, which would be even lower if we had assumed a phase-in period. The Urban Institute estimates would also be
lower if we had assumed hospitals would be paid at Medicare rates , instead of reimbursing hospitals at the level of their
costs. The Urban Institute assumed that prescription drugs would be paid for at levels midway between
Medicare and Medicaid rates; it is not clear from the Mercatus Center analysis how they derived their prescription drug cost savings.
The Urban Institute analysis may also have estimated larger increases in health care utilization because the currently
insured would have comprehensive first-dollar coverage under the reform (Blahous 2018, 9; Holahan et al. 2016, 10).
The two research teams have made similar assumptions on the level of administrative costs associated with the
single-payer plans, and thus their estimated savings from lower average administrative costs seem similar .
Both teams’ estimates indicate that federal spending on health care (Medicare, Medicaid, tax subsidies, and other federal
payments) would more than double under the Sanders proposal. It would also increase total federal government
spending, both mandatory and discretionary, by about 50 percent in 2022 (Blahous 2018) and 60 percent in 2017 (Holahan et al. 2016). 4
The studies’ estimates of national health expenditures also differ. The Urban Institute estimates that, under Sanders’s presidential campaign plan,
national health spending would have increased by $450.5 billion in 2017 (without long-term services and supports), or by
about 13 percent. The Mercatus Center study estimates $93 billion in health savings in 2022, or a 2.0 percent decrease in spending, E S T I M A T
I N G T H E C O S T O F A S I N G L E-P A Y E R P LA N 3 though
savings would decrease once the plan was fully
phased in. The difference between a 13 percent increase and a 2 percent decrease in national health spending is
largely attributable to the studies’ different assumptions about hospital payment rates and the Mercatus Center’s
use of a phase-in schedule. And, although the Mercatus Center study assumed Medicare provider payment rates in its central estimates, the report
includes estimates with higher assumed payment rates too. Charles Blahous, author of the Mercatus Center study, has said that, although he used
Medicare hospital and physician payment rates as specified in the MFA bill, he believes the payment rates would be significantly
higher in practice.5 The Mercatus Center paper does provide alternative estimates of the effects of MFA with higher payment rates that
yield a $219 billion increase in national health expenditures in 2022. This compares with the Urban Institute’s estimated increase in National
Health Expenditures of $450.5 billion in 2017, noted above. Although the studies’ findings are not directly comparable as
published, after taking different assumptions into account and making adjustments for them, the estimates
of the impact on both federal and national health spending are not substantively different . A health reform
that provides such a large increase in coverage with very broad benefits and essentially no cost-sharing
requirements will lead to higher levels of national expenditures, even when private sector provider
payment rates are reduced to the level of provider costs. Reducing provider payment rates further risks
creating provider supply shortages and impeding access to necessary medical care. Having the federal government
take responsibility for national health spending would mean an extremely large impact on the federal budget ,
although it would create substantial private sector savings by eliminating employers’ and households’
premium and direct spending on care. Lowering provider payment rates to the levels suggested in the Urban Institute analysis
would still best be phased in over a considerable period to minimize disruption to the health care system.
Even the payment rate cuts assumed in the Urban Institute study could be politically infeasible to implement. If so, estimates in both
studies could significantly understate the federal and system-wide costs of this reform . Rather than significant,
abrupt reductions in provider payment rates, a more practical goal may be to put a system in place that would focus
more on slowing the rate of growth in per capita health care spending to approximate the growth in per capita gross domestic
product. Once that goal is reached, further savings could be achieved by modest, incremental reductions in provider
payment rates. If that can be achieved, increases in economic output would not be disproportionately devoted to increasing health spending.
Per capita health spending in the US could remain considerably higher than that of other nations, but the difference would decrease over time.

Admin costs are key to quality control and fraud which outweigh AND the
percentage of admin costs has been stable for a decade, so it doesn’t explain rising
costs.
Dana Goldman 17, Director of the Leonard D. Schaeffer Center for Health Policy and Economics at
the University of Southern California, 10-30-2017, "MEDICARE‐FOR‐ALL: NOT OUR ONLY
OPTION FOR UNIVERSAL COVERAGE," Journal of Policy Analysis and Management, Volume 37,
Issue 1 Winter 2018 Pages 195–198,
ADMINISTRATIVE COSTS ARE NOT ALWAYS THE ENEMY Medicare has also become the darling of health insurance
reform for its low administrative costs, which Dr. Gaffney argues would balance out the extraordinary expense of implementing a single-payer system. It is pretty
widely accepted that Medicare spends less of its budget on administration than private plans do—estimates put Medicare at around 2 percent and private health plans
at about 12 percent (Woolhandler & Himmelstein, 2017b). Administrative spending in the United States is also higher than in other countries, 31 percent compared to
Canada's 16.7 percent in 1999 (Woolhandler, Campbell, & Himmelstein, 2003). Dr. Gaffney also cites a claim that a U.S. single-payer plan could bring about
“bureaucratic” savings as high as $500 billion, due to such cost-cutting measures as reducing provider billing paperwork by creating simplified, uniform billing
procedures (Woolhandler & Himmelstein, 2017b). The
facts may be accurate, but the argument is backwards. Medicare's
problem is that it spends too little on administration . It pays for all services, regardless of cost,
reviews nothing, and ends up with a financing scheme that is rife with provider and supplier fraud .
Investigators have uncovered “widespread, organized, and lucrative schemes to bilk Medicare out of an
estimated $60 billion dollars per year” (Potter, 2007). Even taking into account efforts to better target
Medicare's audit system (CMS, 2017), which could make a dent in fraud enforcement, an insurer that
covers first and reviews later (in essence, does no “upstream rationing”) is more likely to make some
bad calls . In 2003, Medicare decided to pay for left ventricular assist devices for patients with end-stage
heart failure. The devices can cost Medicare $200,000 or more, but studies found patient survival is very
poor (Hernandez et al., 2008). The increased mortality and costs from a misstep such as this one far
outweigh savvy administrative spending. Finally, even if one thinks administrative costs are too high,
they do not explain the growth in health care spending. The percentage the United States spends on
administration has not changed in at least the last decade, while our overall health care costs have
ballooned . It makes more sense to address cost-saving measures that will attack this larger problem rather
than pick only on administrative spending.

They are good—spreads fixed costs and creates capital investments---the alternative
is chronic shortages by non-adaptive services.
Richard A. Epstein 17, Peter and Kirsten Bedford Senior Fellow at the Hoover Institution, the Laurence
A. Tisch Professor of Law, New York University Law School, and senior lecturer at the University of
Chicago, “Why a Single Payer Health Care System is a Really Bad Idea,” 7/18/17,
http://www.newsweek.com/why-single-payer-health-care-system-really-bad-idea-638334
To Frank, one of the two obvious sources of savings are the elimination of competitive
advertisements, which he notes can run to 15 percent of total
costs. Yet he links to an article that sends a very different message. It praises how additional
advertisement can fuel needed revenue
growth . Frank is also blind to the benefits of advertisement, which allow consumers to learn of the full range of services
of benefit to them. That increased demand can allow firms to spread their fixed costs over a larger
customer base , thereby reducing average costs . Advertisements may not be needed for a national health plan, but only for the worst of
all reasons. Legislative menus of mandated goods are so rigid and standardized that firms have nothing new

to sell . But this in turn reveals the weakness of a top heavy health care plan, namely not developing a sensible
innovation policy because of the inability to market its fruits. It also leads to a systematic reduction in long-term capital
investment , which translates into chronic shortages tomorrow.

The plan would increase overhead dramatically because the system will run on
regulations instead of prices.
Arnold Kling 7, adjunct scholar with the Cato Institute, 11-28-2007, "Government and Health Care: The
Good, The Bad, and the Ugly," Cato Institute,
https://www.cato.org/publications/commentary/government-health-care-good-bad-ugly
The amount that a country spends on health care is mostly a function of supply. In fact the amount that an
individual state within the U.S. spends on health care is mostly a function of supply . One of the reasons that
Massachusetts is a difficult state in which to try to offer universal coverage is that the supply of specialists and high-tech equipment is so high there . Given the

vast supply of expensive health care providers in the United States, there is reason to doubt that
shifting to a universal system provided by government would bring down spending. Government is
not as efficient as it might seem. While the government can operate without profits, it cannot operate
without taxes. Taxes discourage work, thrift, and risk-taking . The deadweight loss from taxes as a
percentage of revenue is higher than insurance company profits as a percentage of their revenue.
As to eliminating overhead, if all of private health insurance were ended, government would face a new
responsibility: setting price schedules for every medical service in every section of the country . As it
stands today, prices are negotiated with private insurers, and government programs feed off of these
“usual and customary” charges. Deprived of this market information, government would have more
overhead and would have difficulty correctly assessing the relative values of different services .

The plan causes immediate panic regardless of implementation details – companies

see writing on wall.
Daniel Summers 16, pediatrician in the greater Boston area., 2-19-2016, "I’m a Doctor. Here’s Why I
Oppose the Single-Payer Revolution.," New Republic, https://newrepublic.com/article/130145/im-doctor-
heres-oppose-single-payer-revolution
What is not disputed to any great degree is that Sanders
would reduce payments to doctors and hospitals. His “Medicare for all” plan
I have
would result in a substantial reduction in revenue compared to what most private insurance plans currently pay. As a pediatrician in private practice,

grave concerns that implementing a rapid transition to a single-payer system would be far more disruptive to many
Americans’ health care than Sanders cares to discuss. An incremental increase in Medicare eligibility would create a
de facto public option , the lack of which was my single greatest objection to the Affordable Care Act. But in order for Medicare to become a single-
payer system for everyone, patients must be left with no option. Sanders’s plan, presumably accomplished through legislative action, would require the summary
voiding of every contract medical providers have with all the insurance plans they accept. Even in the unlikely event that Sanders gets this plan through a recalcitrant
Congress, it is anyone’s guess whether it would withstand the wave of lawsuits that would doubtless ensue. But even if the plan survives these practical challenges, it
makes a mockery of the notion that people can keep the plan they have if they’re happy with their current coverage, one of the ACA’s biggest selling points (for which
President Barack Obama got into some trouble when those promises fell short). Whether or not I could still refer patients to the specialists I typically prefer, chosen
because my practice trusts the quality of care they deliver, would be in question. Controlling medical expenditures is a necessary goal, no matter what health care
system we have, but putting everyone on the same plan without acknowledging restricted choices as an inevitable consequence isn’t telling the whole story. Compared
to the lustrous ideals that inform the pursuit of a single-payer system, talking about profitability seems downright grungy. But businesses need to stay
profitable in order to stay afloat, and medical practices are no different. Even not-for-profits need sufficient revenue to keep the doors open.
Talking about substantially reducing payment to medical providers in one fell swoop, as though doctors
and hospitals will say, “Alrighty then,” and carry on providing the exact same services without any appreciable change to patients strains
credulity. For my practice, it would immediately put pressure on us to eliminate services we provide that do not
generate any revenue. As it stands, every patient of ours who gets admitted to the hospital is seen by one of our providers, even if they’re not admitted to
our service. We visit our patients in the hospital every day because we believe strongly that doing so keeps us informed about and involved in the management of our
patients’ care, even if we’re not ultimately in charge of that care at any given time. It generates no income for the practice when we do this, and it’s hard to see how
we could keep paying providers for this service when they could be in the office seeing patients instead. Further, every well-child exam at our practice is scheduled for
a full 30 minutes, and for medically complex patients we dedicate an entire hour. Giving ample time to discuss each patient’s care thoroughly, answer all the parents’
questions, and offer guidance about important health and safety issues is a value we hold strongly. But the pressure to maximize patient volume could put that value in
jeopardy. And despite pressure to see as many patients as possible, it’s still very likely that we would need to reduce payroll costs to stay in
the black. Even if you factor in a reduction in our already-thin billing personnel (a prospect I don’t greet with any joy, as these are employees I care about), and
even with the substantial haircut my partners and I would doubtless take to support our staff as much as possible, we’d have to pay our providers
less. This may be a matter of blithe unconcern to advocates of Sanders’s plan, but it would almost certainly mean we’d have to make
compromises in what we ask our providers to do. We’re currently open seven days a week. Even on major holidays, we make a provider
available for urgent sick visits to the office. If you call our number outside regular office hours, at any time of the day, it’s one of our physicians or nurse practitioners
who gets the page. It’s hard to see us maintaining that level of availability while simultaneously cutting the pay of people who show up on Sundays and take those two
o’clock in the morning phone calls. Could we make all the changes necessary to make it worthwhile to stay in business? I hope so. It would be a grimmer place to
work, to be sure, but we’d try to make it happen. However, I have no doubt many
offices would see the writing on the wall . Some
may try to sell to hospitals, which certainly won’t keep them open at a loss , and others will close
outright . Who will assume care for the thousands of patients these closures would displace is not a
question I see answered in Sanders’s plans. The government can provide insurance, but providing care directly is an even more ambitious change than
Sanders is already proposing. A phased-in approach to expanded Medicare enrollment, while allowing other payers to remain intact, would

obviously be far less disruptive. Gradual shifts in the multiple-payer system are much easier to
accommodate than a sudden large reduction in revenue. Given the choice between “adjust next year’s
budget” and “batten down the hatches,” I’d just as soon pick the former. But these incremental changes are not the revolution Sanders is
advocating. Fans of single-payer may well be willing to make sacrifices in terms of patient choice or provider availability. However, it does not withstand

scrutiny to say that hospitals and doctors will take a big decrease in compensation without patients feeling
the burn in a painful way. As with all things in medicine, a full discussion of risks and benefits must be had before a truly informed decision can be
made.
 1NR
Their evidence assumes a level of virulence that has literally never occurred
Wendy Orent 15, anthropologist and freelance science writer whose work has appeared in The
Washington Post, The LA Times, The New Republic, Discover, and The American Prospect, instructor in
science journalism @ Emory, Ignore predictions of lethal pandemics and pay attention to what really
matters, LA Times, 1/3/15, http://www.latimes.com/opinion/op-ed/la-oe-orent-pandemic-hysteria-
20150104-story.html

Prophets of doom have been telling us for decades that a deadly new pandemic — of bird flu, of SARS or MERS coronavirus, and now
of Ebola — is on its way. Why are we still listening? If you look back at the furor raised at many distinguished publications — Nature, Science, Scientific American, National

Geographic — back in, say, 2005, about a potential bird flu (H5N1) pandemic, you wonder what planet they were on. Nature ran a special section titled — “Avian flu: Are

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

hysteria still goes on: Whether it's over the

followed that with “But note the may,” the article went on to paint a terrifying picture of the avian flu threat nonetheless. And such

MERS coronavirus, a whole alphabet of chicken flu viruses, a real but not very deadly in flu enza pandemic in 2009, or a
kerfuffle like the one in 2012 over a scientist-crafted ferret flu that also was supposed to be a pandemic threat. Along the way,

virologist Nathan Wolfe published “The Viral Storm: the Dawn of a New Pandemic Age,” and David Quammen warned in his gripping “Spillover” that some

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

The scientific world has

were discounted by serious scientists, and Garrett seemingly retracted her earlier hysteria about Ebola by claiming that, after all, evolution made such spread unlikely.

changed since 2005. Now, most scientists understand that there are significant physical and
evolutionary barriers to a blood- and fluid-borne virus developing airborne transmission , as Garrett has
acknowledged. Though Ebola virus has been detected in human alveolar cells, as Vincent Racaniello, virologist at Columbia University, explained to me, that doesn't mean it can replicate in the airways enough to allow transmission.
“Maybe … the virus can get in, but can't get out. Like a roach motel,” wrote Racaniello in an email. H5N1, we understand now, never went airborne because it attached only to cell receptors located deep in human lungs, and could
not, therefore, be coughed or sneezed out. SARS, or severe acute respiratory syndrome, caused local outbreaks after multiple introductions via air travel but spread only sluggishly and mostly in hospitals. Breaking its chains of

There probably will always be significant barriers preventing the easy adaptation of
transmission ended the outbreak globally.

an animal disease to the human species. Furthermore, Racaniello insists that there are no recorded instances of viruses that
have adapted to humans, changing the way they are spread. So we need to stop listening to the
doomsayers, and we need to do it now. Predictions of lethal pandemics have — since the swine flu fiasco
of 1976, when President Ford vowed to vaccinate “every man, woman and child in the United States” — always been wrong. Fear-mongering wastes our time
and our emotions and diverts resources from where they should be directed — in the case of Ebola, to the ongoing tragedy in West Africa.
Americans have all but forgotten about Ebola now, because most people realize it isn't coming to a school or a shopping mall near you. But Sierra Leoneans and Liberians go on dying.

Genetic variations and adaption solves – plus, no known disease has the potential to
kill everyone
Amesh Adalja 16, infectious-disease physician at the University of Pittsburgh, 6/17/16, “Why Hasn't
Disease Wiped out the Human Race?,” https://www.theatlantic.com/health/archive/2016/06/infectious-
diseases-extinction/487514/
But whenpeople ask me if I’m worried about infectious diseases, they’re often not asking about the threat to
human lives; they’re asking about the threat to human life . With each outbreak of a headline-grabbing emerging infectious
disease comes a fear of extinction itself . The fear envisions a large proportion of humans succumbing to
infection, leaving no survivors or so few that the species can’t be sustained . I’m not afraid of this apocalyptic
scenario, but I do understand the impulse. Worry about the end is a quintessentially human trait . Thankfully, so is our
resilience . For most of mankind’s history, infectious diseases were the existential threat to humanity—and for good
reason. They were quite successful at killing people: The 6th century’s Plague of Justinian knocked out an estimated 17 percent of the world’s
population; the 14th century Black Death decimated a third of Europe; the 1918 influenza pandemic killed 5 percent of the world; malaria is
estimated to have killed half of all humans who have ever lived. Any yet, of course, humanity continued to flourish. Our species’
recent explosion in lifespan is almost exclusively the result of the control of infectious diseases through sanitation, vaccination, and antimicrobial
therapies. Only in the modern era, in which many infectious diseases have been tamed in the industrial world, do people have the luxury of death
from cancer, heart disease, or stroke in the 8th decade of life. Childhoods are free from watching siblings and friends die from outbreaks of
typhoid, scarlet fever, smallpox, measles, and the like. So what would it take for a disease to wipe out humanity now? In
Michael Crichton’s The Andromeda Strain, the canonical book in the disease-outbreak genre, an alien microbe threatens the human race with
extinction, and humanity’s best minds are marshaled to combat the enemy organism. Fortunately, outside of fiction, there’s no reason to expect
alien pathogens to wage war on the human race any time soon, and my analysis suggests that any real-life domestic microbe reaching an
extinction level of threat probably is just as unlikely. Any
apocalyptic pathogen would need to possess a very special combination
of two attributes. First, it would have to
be so unfamiliar that no existing therapy or vaccine could be applied to it.
Second, it would need to have a high and surreptitious transmissibility before symptoms occur. The first is essential
because any microbe from a known class of pathogens would, by definition, have family members that could
serve as models for containment and countermeasures . The second would allow the hypothetical disease to spread
without being detected by even the most astute clinicians. The three infectious diseases most likely to be considered extinction-level threats in the
world today—influenza, HIV, and Ebola—don’t meet these two requirements. Influenza, for instance, despite its well-established ability to kill
on a large scale, its contagiousness, and its unrivaled ability to shift and drift away from our vaccines, is still what I would call a “known
unknown.” While
there are many mysteries about how new flu strains emerge, from at least the time of Hippocrates,
humans have been attuned to its risk . And in the modern era, a full-fledged industry of influenza preparedness exists, with
effective vaccine strategies and antiviral therapies. HIV, which has killed 39 million people over several decades, is similarly limited due to
several factors. Most importantly, HIV’s dependency on blood and body fluid for transmission (similar to Ebola) requires intimate human-to-
human contact, which limits contagion. Highly potent antiviral therapy allows most people to live normally with the disease, and a substantial
group of the population has genetic mutations that render them impervious to infection in the first place. Lastly, simple prevention strategies such
as needle exchange for injection drug users and barrier contraceptives—when available—can curtail transmission risk. Ebola, for many of the
same reasons as HIV as well as several others, also falls short of the mark. This is especially due to the fact that it spreads almost exclusively
through people with easily recognizable symptoms, plus the taming of its once unfathomable 90 percent mortality rate by simple supportive care.
Beyond those three, every other known disease falls short of what seems required to wipe out humans—which
is, of course, why we’re still here. And it’s not that diseases are ineffective. On the contrary, diseases’ failure to knock us
out is a testament to just how resilient humans are. Part of our evolutionary heritage is our immune system, one of
the most complex on the planet, even without the benefit of vaccines or the helping hand of antimicrobial drugs.
This system, when viewed at a species level , can adapt to almost any enemy imaginable . Coupled to
genetic variations amongst humans—which open up the possibility for a range of advantages, from imperviousness to infection to a
tendency for mild symptoms—this adaptability ensures that almost any infectious disease onslaught will leave a
large proportion of the population alive to rebuild , in contrast to the fictional Hollywood versions.
While the immune system’s role can never be understated, an even more powerful protector is the faculty of consciousness. Humans are not the
most prolific, quickly evolving, or strongest organisms on the planet, but as Aristotle identified, humans are the rational animals—and it is this
fundamental distinguishing characteristic that allows humans to form abstractions, think in principles, and plan long-range. These capacities, in
turn, allow humans to modify, alter, and improve themselves and their environments. Consciousness equips us, at an individual and a species
level, to make nature safe for the species through such technological marvels as antibiotics, antivirals, vaccines, and sanitation. When humans
began to focus their minds on the problems posed by infectious disease, human life ceased being nasty, brutish, and short. In many ways, human
consciousness became infectious diseases’ worthiest adversary. None of this is meant to allay all fears of infectious diseases. To totally adopt a
Panglossian viewpoint would be foolish—and dangerous. Humans do face countless threats from infectious diseases: witness Zika. And if not
handled appropriately, severe calamity could, and will, ensue. The West African Ebola outbreak, for instance, festered for months before major
efforts to bring it under control were initiated. When it comes to infectious diseases, I’m worried about the failure of
institutions to understand the full impact of outbreaks. I’m worried about countries that don’t have the infrastructure or
resources to combat these outbreaks when they come. But as long as we can keep adapting, I’m not worried about
the future of the human race.
Technical barriers prevent synthetic pathogens.
Eckard Wimmer 18. Professor at Stony Brook University. 2018. “Synthetic Biology, Dual Use
Research, and Possibilities for Control.” Defence Against Bioterrorism, Springer, Dordrecht, pp. 7–11.
link.springer.com, doi:10.1007/978-94-024-1263-5_2.

Listed below are some constraints that show how in the US the
development of dangerous infectious agents, referred to as “ select
agents ”, is controlled – perhaps misuse even prevented – through technical and administrative hurdles : I. Re-
creating an already existing dangerous virus for malicious intent is a complex scientific endeavor . (i) It
requires considerable scientific knowledge and experience and, more importantly, considerable financial
support . That support usually comes from government and private agencies (NIH, NAF, etc.), organizations that
carefully screen at multiple levels all applications for funding of ALL biological research . (ii) It requires an
environment suitable for experimenting with dangerous infectious agents ( containment facilities).
Any work in containment facilities is also carefully regulated. II. Genetic engineering to synthesize or modify
organisms relies on chemical synthesis of DNA. Synthesizing DNA is automated and carried out with

sophisticated, expensive instruments. The major problem of DNA synthesis, however, is that the product is not
error-free . Any single mistake in the sequence of small DNA segments (30–60 nucleotides) or large segments (>500 nucleotides) can ruin
the experiment . Companies have developed strategies to produce and deliver error free, synthetic DNA,
which investigators can order electronically from vendors, such as Integrated DNA Technologies (US), GenScript (US) or GeneArt
(Germany). This offers a superb and easy way to control experimental procedures carried out in any laboratory : the

companies will automatically scan ordered sequences in extensive data banks to monitor relationship to
sequences of a select agent . If so, the order will be stalled until sufficient evidence has been provided by the investigator that she/he
is carrying out experiments approved by the authorities. The entire complex issue of protecting society from the misuse of select agents has been discussed in two
outstanding studies [11, 12]. III. Engineering
a virus such that it will be more harmful (more contagious, more pathogenic) is
generally difficult because, in principle, viruses have evolved to proliferating maximally in their
natural environment . That is, genetic manipulations of a virus often lead to loss of fitness that, in turn,
is unwanted in the bioterrorist agent.

no motive or technical ability.

Filippa Lentzos 17. Senior research fellow jointly appointed in the Departments of War Studies and of
Global Health and Social Medicine at King’s College London. “Ignore Bill Gates: Where bioweapons
focus really belongs.” Bulletin of the Atomic Scientists. http://thebulletin.org/ignore-bill-gates-where-
bioweapons-focus-really-belongs10876.
Bioterrorism seems to be back in fashion. In the past, it has received bursts of attention that arose from
particular incidents—the “anthrax letters” sent through the mail to US politicians and media outlets in
2001, for instance, or the purchase of plague bacteria by white supremacist Larry Wayne Harris in 1995.
This time, it’s an unlikely individual calling attention to the bioterror threat—Bill Gates, the Microsoft
founder turned philanthropist. Over the last several years, the world’s richest man has spent vast sums of
money on global health, and in the last few months he has turned his attention to bioterrorism. At a high-
profile security summit in Munich in February, he warned that bioterrorism could kill tens of millions. At
a London security meeting a couple of months later, he said terrorists could wipe out 30 million people by
weaponizing a disease such as smallpox.
I disagree. At a stretch, terrorists taking advantage of advances in biology might be able to create a viable
pathogen. That does not mean they could create a sophisticated biological weapon, and certainly not a
weapon that could kill 30 million people. Terrorists in any event tend to be conservative . They use
readily available weapons that have a proven track record —not unconventional weapons that are
more difficult to develop and deploy . Available evidence shows that few terrorists have ever even
contemplated using biological agents, and the extremely small number of bioterrorism incidents in the
historical record shows that biological agents are difficult to use as weapons. The skills required to
undertake even the most basic of bioterrorism attacks are more demanding than often assumed. These
technical barriers are likely to persist in the near- and medium-term future.

Every empiric AND basic theories of evolution disprove any risk of extinction from
disease
Bryan Walsh 20, Future Correspondent for Axios, Editor of the Science and Technology Publication
OneZero, Former Senior and International Editor at Time Magazine, BA from Princeton University, End
Times: A Brief Guide to the End of the World, Orion Publishing Group, Limited Edition, p. 183-185

Yet despiteepidemic after epidemic , despite mass killers like smallpox and the 1918 flu , at no point has
disease threatened humans with extinction . Even the Black Death , likely the most concentrated epidemic of all time,
now appears as little more than a minor downturn in what has otherwise been a bull market for long-
term human population growth. That’s true for animals as well. The International Union for Conservation of Nature reports that of
the 833 plant and animal extinctions that have been documented since 1500, less than 4 percent can be
attribute d to infectious disease. Those species that were eradicated by disease tended to be small in number
and geographically isolated —very much unlike human beings, who are both numerous and have
spread to every corner of the world.38

With the exception of HIV—which can now be managed as a chronic condition with antiviral drugs— every major epidemic mentioned
above took place before the dawn of modern medicine , before the development of antibiotics and widespread
vaccines . Smallpox was even fully eradicated from the wild in 198039—the only known samples of the virus are kept at highly secure
government facilities in Atlanta and Koltsovo, Russia.40 Plague is now so rare that when it breaks out in countries like Madagascar, it makes
global news—yet fewer than 600 deaths from the disease were reported between 2010 and 2015. Studies have shown that most of the fatalities
from the 1918 flu were actually due to secondary bacterial infections that today could be controlled by antibiotics,41 which were introduced less
than a century ago. Influenza pandemics remain the great fear of infectious disease experts, but the most recent one in 2009 killed only about
284,000 people worldwide.42 That was fewer than the number of people who die from seasonal flu in an ordinary year.43

Modern science has defanged most infectious diseases, at least outside the developing world—and great progress has been
made there in recent years—but basic evolution also plays a role in limit ing the catastrophic potential of natural
disease. Every pathogen faces a trade-off . In general, the more rapidly it kills, the harder it is to spread
widely, because an extremely virulent disease would run out of victims and hit an epidemiological dead
end. Pathogens that are highly transmissible , like influenza, rarely kill , even absent the
countermeasures of modern medicine. The 1918 flu had a fatality rate of about 2.5 percent.44 That’s tremendously high by the
standards of the flu, but it still meant that more than 97 out of every 100 patients survived. Even a virus like HIV—which kills slowly and shows
no symptoms for years, permitting the infected plenty of time to spread the disease—is hindered because transmission requires direct contact with
blood or with bodily fluids. The self-replication that makes infectious disease such an effective weapon also prevents it from becoming a true
existential threat. What viruses and bacteria want—if packets of genes and single-celled organisms can be said to want anything—is to survive
and to replicate. They can’t do that if they kill all humans.
Interconnectedness is balanced by increased immunity and advances in medicine
and sanitation
Dr. John Halstead 19, Doctorate in Political Philosophy, “Cause Area Report: Existential Risk,
Founders Pledge”, https://founderspledge.com/research/Cause%20Area%20Report%20-%20Existential
%20Risk.pdf

natural ly occurring pathogens are unlikely to cause human extinction.

However, there are some reasons to think that
Firstly, Homo sapiens have been around for 200,000 years and the Homo genus for around six million years without
being exterminated by an infectious disease, which is ev idence that the base rate of extinction-risk
natural pathogens is low .82 Indeed, past disease outbreaks have not come close to rendering humans extinct.
Although bodies were piled high in the streets across Europe during the Black Death,83 human extinction was never a serious possibility, and
some economists even argue that it was a boon for the European economy.84 Secondly, infectious disease has only
contributed to the extinction of a small minority of animal species .85 The only confirmed case of a
mammalian species extinction being caused by an infectious disease is a type of rat native only to Christmas
Island . Having said that, the context may be importantly different for modern day humans, so it is unclear whether the risk is increasing or
decreasing. On the one hand, due to globalisation, the world is more interconnected making it easier for pathogens to spread. On the other hand,
interconnectedness could also increase immunity by increasing exposure to lower virulence strains
between subpopulations .87 Moreover, advancements in medicine and sanitation limit the potential damage
an outbreak might do.

Humans are too dispersed and disease trends against lethality

Sebastian Farquhar 17, director at Oxford's Global Priorities Project, Owen Cotton-Barratt, a Lecturer
in Mathematics at St Hugh’s College, Oxford, John Halstead, Stefan Schubert, Haydn Belfield, Andrew
Snyder-Beattie, "Existential Risk Diplomacy and Governance", GLOBAL PRIORITIES PROJECT 2017,
1/23/2017, https://www.fhi.ox.ac.uk/wp-content/uploads/Existential-Risks-2017-01-23.pdf
1.1.3 Engineered pandemics For most of human history, natural pandemics have posed the greatest risk of mass global fatalities.37 However,
there are some reasons to believe thatnatural 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

Their ev assumes a level of virulence that has literally never occurred

Wendy Orent 15, anthropologist and freelance science writer whose work has appeared in The
Washington Post, The LA Times, The New Republic, Discover, and The American Prospect, instructor in
science journalism @ Emory, Ignore predictions of lethal pandemics and pay attention to what really
matters, LA Times, 1/3/15, http://www.latimes.com/opinion/op-ed/la-oe-orent-pandemic-hysteria-
20150104-story.html
Prophets of doom have been telling us for decades that a deadly new pandemic — of bird flu, of SARS or MERS coronavirus, and now
of Ebola — is on its way. Why are we still listening? If you look back at the furor raised at many distinguished publications — Nature, Science, Scientific American, National

Geographic — back in, say, 2005, about a potential bird flu (H5N1) pandemic, you wonder what planet they were on. Nature ran a special section titled — “Avian flu: Are

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

hysteria still goes on: Whether it's over the

followed that with “But note the may,” the article went on to paint a terrifying picture of the avian flu threat nonetheless. And such

MERS coronavirus, a whole alphabet of chicken flu viruses, a real but not very deadly in flu enza pandemic in 2009, or a
kerfuffle like the one in 2012 over a scientist-crafted ferret flu that also was supposed to be a pandemic threat. Along the way,

virologist Nathan Wolfe published “The Viral Storm: the Dawn of a New Pandemic Age,” and David Quammen warned in his gripping “Spillover” that some

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

The scientific world has

were discounted by serious scientists, and Garrett seemingly retracted her earlier hysteria about Ebola by claiming that, after all, evolution made such spread unlikely.

changed since 2005. Now, most scientists understand that there are significant physical and
evolutionary barriers to a blood- and fluid-borne virus developing airborne transmission , as Garrett has
acknowledged. Though Ebola virus has been detected in human alveolar cells, as Vincent Racaniello, virologist at Columbia University, explained to me, that doesn't mean it can replicate in the airways enough to allow transmission.
“Maybe … the virus can get in, but can't get out. Like a roach motel,” wrote Racaniello in an email. H5N1, we understand now, never went airborne because it attached only to cell receptors located deep in human lungs, and could
not, therefore, be coughed or sneezed out. SARS, or severe acute respiratory syndrome, caused local outbreaks after multiple introductions via air travel but spread only sluggishly and mostly in hospitals. Breaking its chains of

There probably will always be significant barriers preventing the easy adaptation of
transmission ended the outbreak globally.

an animal disease to the human species. Furthermore, Racaniello insists that there are no recorded instances of viruses that
have adapted to humans, changing the way they are spread. So we need to stop listening to the
doomsayers, and we need to do it now. Predictions of lethal pandemics have — since the swine flu fiasco
of 1976, when President Ford vowed to vaccinate “every man, woman and child in the United States” — always been wrong. Fear-mongering wastes our time
and our emotions and diverts resources from where they should be directed — in the case of Ebola, to the ongoing tragedy in West Africa.
Americans have all but forgotten about Ebola now, because most people realize it isn't coming to a school or a shopping mall near you. But Sierra Leoneans and Liberians go on dying.