1NC

1
NHI leads to government rationing and higher costs---
overconsumption causes government restrictions on access
Kel Kelly 11, Wall Street trader, a corporate finance analyst, and a research director for a Fortune
500 management consulting firm. 3/9/11, “The Myth of Free-Market Healthcare”
https://mises.org/library/myth-free-market-healthcare
Socialists want us to turn to nationalized
healthcare, where the state will pay for our healthcare (as though we
will not still be paying for it). But this will
not work either.[6] When medical care is free, people consume
more of it. The costs would continually rise, as they currently do in the United States. Because
national governments have limited budgets, governments with socialized medicine impose
cost controls and limit spending to a particular amount. But because nothing limits individuals from
going to the doctor, waiting lines grow longer and longer.
At this point governments limit doctor visits or limit the types of procedures that can be done. For
example, a particular treatment might only be authorized given the existence of a particular set of other symptoms. Or surgery
might be restricted to patients who are under a given age . After getting sick, famed British record-label owner,
radio and TV presenter, nightclub owner, and journalist Tony Wilson (about whom the film 24 Hour Party People was made) faced
death due to the fact that Britain's National Health Service (NHS) refused to fund an expensive cancer drug he needed to stay alive.
He stated, "I've never paid for private health care because I'm a socialist. Now I find you can get tummy tucks and cosmetic surgery
on the NHS but not the drugs I need to stay alive. It is a scandal." Wilson died not long after in 2007.[7]

In England's state-run system, the waiting list is nearly 800,000 people. This is in addition to
those denied medical attention: 7,000 for hip replacements; between 4,000 and 20,000 for coronary bypass surgery;
10,000 to 15,000 for cancer chemotherapy. Even with our current, screwed-up system one can get treatment if they, or their friends
or charities, can pay the price. Under
socialized medicine, where many are prevented by the government
from getting care, the socialist's "right" to healthcare certainly goes out the window.

Wait times are key indicators of medical tourism- uniquely true for
US
Laura Hopkins et al. 10 , School of Public Health, University of Saskatchewan, Ronald
Labonte, Viven Runnels, and Corinne Packet, Globalization and Health Equity,Institute of
Population Health, University of Ottawa, “Medical tourism tody: What is the state of existing
knowledge?” Macmillan Publishers. Journal of Public health Policy Vol. 31, 2, p.184-198. July
2010.
According to the most widely accepted estimate, nearly
350000 patients from developed nations traveled to a
variety of developing countries for health care in 2003.9 A 2008 report by Deloitte Center for Health Solutions,
based on an online survey sample of 3000 in the United States and ‘internal analyses’ (the methods for which are not described),
forecasts the number of medical tourists to rise from 750 000 in 2007 to approximately 5.25 and
6.25 million by 2010, and approximately 10.5 and 23.2 million by 2017.7 We use these estimates with
caution for lack of an alternative – noting that in other developed countries waiting times may
increase the numbers.10 As one indicator of increasing cross-border patient flows, even from
countries with publicly financed universal health care, the province of Ontario, Canada saw a 450 per
cent increase from 2001 to 2008 in the number of patients reimbursed for out-of-country
medical treatment.11 Even though much of this care likely took place in the United States, the substantial increase
signals the potential of new involvement of public health systems with foreign care facilities,
including one that Indian hospital representa- tives recently sought to promote at a medical tourism conference in Toronto, Canada
in late 2009.
Medical tourism undermines public health systems
Glenn Cohen 11, Assistance Professor and Co-Director of the Center for Health Law Policy,
Biotechnology and Bioethics, Harvard Law School, JD from Harvard Law, Medical Tourism,
Access to Health Care, and Global Justice, Virgina Journal of International Law, Vol 52(1),
http://www.vjil.org/assets/pdfs/vol52/issue1/Cohen_Final.pdf
Medical tourism — the travel of patients who are residents of one country (the “home country”)
to another country for medical treatment (the “destination country”) — represents a growing and
important business. For example, by one estimate, in 2004, more than 150,000 foreigners sought medical
treatment in India, a number that is projected to increase by fifteen percent annually for the
next several years.1 Malaysia saw 130,000 foreign patients in the same year.2 In 2005,
Bumrungrad International Hospital in Bangkok, Thailand, alone saw 400,000 foreign patients, 55,000 of
whom were American (although these numbers are contested).3 By offering surgeries such as hip and heart valve
replacements at savings of more than eighty percent from that which one would pay out of
pocket in the United States, medical tourism has enabled underinsured and uninsured
Americans to secure otherwise unaffordable health care.4 The title of a recent Senate hearing — “The
Globalization of Health Care: Can Medical Tourism Reduce Health Care Costs?” — captures the promise of medical tourism.5 U.S.
insurers and self-insured businesses have also made attempts to build medical tourism into
health insurance plans offered in the United States, and states like West Virginia have
considered incentivizing their public employees to use medical tourism .6 There have even been calls for
Medicaid and Medicare to incentivize medical tourism for their covered populations.7 ¶ Although hardly new, in recent years, the
dramatic increase in the scope of the industry and the increasing involvement of U.S. citizens as
medical tourists to developing countries have made pressing a number of legal and ethical issues.8
While the growth of medical tourism has represented a boon (although not an unqualified one9) for U.S. patients, what about
the interests of those in the destination countries? From their perspective, medical
tourism presents a host of cruel ironies. Vast medico-industrial complexes replete with
the newest expensive technologies to provide comparatively wealthy medical tourists hip
replacements and facelifts coexist with large swaths of the population dying from malaria, AIDS,
and lack of basic sanitation and clean water. A recent New York Times article entitled “Royal Care for Some of
India’s Patients, Neglect for Others,” for example, begins by describing the care given at Wockhardt Hospital in India to “Mr. Steeles,
60, a car dealer from Daphne, Ala., [who] had flown halfway around the world last month to save his heart [through a mitral valve
repair] at a price he could pay.”10 The article describes in great detail the dietician who selects Mr. Steele’s meals, the dermatologist
who comes as soon as he mentions an itch, and Mr. Steeles’s “Royal Suite” with “cable TV, a computer, [and] a mini-refrigerator,
where an attendant that afternoon stashed some ice cream, for when he felt hungry later.”11 This treatment contrasts with the care
given to a group of “day laborers who laid bricks and mixed cement for Bangalore’s construction boom,” many of whom “fell ill after
drinking illegally brewed whisky; 150 died that day.”12 “Not for them [was] the care of India’s best private hospitals,” writes the
article’s author; “[t]hey had been wheeled in by wives and brothers to the overstretched government-run Bowring Hospital, on the
other side of town,” a hospital with “no intensive care unit, no ventilators, no dialysis machine,” where “[d]inner was a stack of white
bread, on which a healthy cockroach crawled.”13 ¶ These kinds of stark
disparities have prompted intuitive discomfort
and critiques in the academic and policy literatures. For example, David Benavides, a Senior
Economic Affairs Officer working on trade for the United Nations, has noted that developed and
developing countries’ attempts at exporting health services sometimes come “at the expense of
the national health system, and the local population has suffered instead of benefiting
from those exports.”14 Rupa Chanda, an Indian professor of business, writes in the World Health
Organization Bulletin that medical tourism threatens to “result in a dual market structure , by
creating a higher-quality, expensive segment that caters to wealthy nationals and foreigners, and
a much lower-quality, resource-constrained segment catering to the poor.”15 While the
“[a]vailability of services, including physicians and other trained personnel, as well as the
availability of beds may rise in the higher-standard centres,” it may come “at the expense of
the public sector, resulting in a crowding out of the local population.”16 FOOTNOTE 16
BEGINS… 16. Id.; see also MILICA Z. BOOKMAN & KARLA K. BOOKMAN, MEDICAL TOURISM IN DEVELOPING COUNTRIES
176 (2007) (“Medical Tourism can thus create a dual market structure in which one segment
is of higher quality and
caters to the wealthy foreigners (and local high-income patients) while a lower quality segment
caters to the poor . . . [such that] health for the local population is crowded out as the best
doctors, machines, beds, and hospitals are lured away from the local poor .”). FOOTNOTE 16 ENDS…
Similarly, Professor Leigh Turner suggests that “the greatest risk for inhabitants of destination
countries is that increased volume of international patients will have adverse
effects upon local patients, health care facilities and economies.”17 He explains that the
kinds of investments destination-country governments must make to compete are in
“specialized medical centres and advanced biotechnologies” unlikely to be accessed by “most
citizens of a country [who] lack access to basic health care and social services .”18 Furthermore,
higher wages for health care professionals resulting from medical tourism may crowd out access
by the domestic poor.19 Thus, “[i]nstead of contributing to broad social and economic development, the provision of
care to patients from other countries might exacerbate existing inequalities and further polarize the
richest and poorest members” of the destination country.20¶ The same point has also been made in several
regional discussions: Janjaroen and Supakankuti argue that in Thailand, medical tourism threatens to both
disrupt the ratio of health personnel to the domestic population and “create a two-tier system
with the better quality services reserved for foreign clients with a higher ability to pay .”21 Similarly,
the Bookmans’ claim that in Cuba, “only one-fourth of the beds in CIREN (the international Center for
Neurological Restoration in Havana) are filled by Cubans, and . . . so-called dollar pharmacies
provide a broader range of medicines to Westerners who pay in foreign currency.” 22 They
describe a medical system so distorted by the effects of medical tourism as “ medical
apartheid, because it makes health care available to foreigners that is not available
to locals.”23 Numerous authors have made similar claims about medical tourism in India.24
Similar concerns have even been raised as to medical tourism in developed countries. For example, an investigation by the Israeli
newspaper Haaretz concluded, “medical tourists enjoy conditions Israelis can only dream of, including very short waiting times for
procedures, the right to choose their own doctor and private rooms . . . [a]nd these benefits may well be coming at the expense of
Israeli patients’ care,” and suggested that allowing medical tourists to move to the front of the line on waiting lists for services meant
that “waiting times for ordinary Israelis will inevitably lengthen — especially in the departments most frequented by medical
tourists, which include the cancer, cardiac and in vitro fertilization units.”25

Weak public health systems increase likelihood of disease spread

Margaret E. Kosal 14, Georgia Institute of Technology, Sam Nunn School of International
Affairs, “A New Role for Public Health in Bioterrorism Deterrence” Dec 10, 2014. Frontiers in
Public Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4261597/
This commentary will explore the creation of new relationships between deterrence, infectious disease, and public health to reduce
the threat of biological terrorism and increase international security. Examining the global spread of re-emerging infectious disease,
such as the re-emergence of polio from northern Nigeria, offers a novel case study for thinking about how to deter potential
bioterrorists who seek to use infectious disease. Polio outbreaks have more directly affected the developing
world compared to the US or other nations with robust public health sectors. This example suggests that
a bioterrorist attack would also be more devastating for developing countries in low-resource
settings compared to the western world. Credibly, communicating this may offer a new approach to deterring bioterrorism by
foreign actors. Although a robust public health sector has long been noted to reduce the vulnerability to a
bioterrorism attack, actively promoting the strength of US public health can also serve as a powerful deterrent in its own
right. The issue of terrorist groups utilizing biological weapons against other states is a mounting
concern, yet little deterrence research in the field of political science addresses methods of dealing with the threat of
bioterrorism. Thus, creating new conversations among the life sciences, public health, and political science can lead to new
perspectives on deterring bioterrorism.

The issue of bioterrorism deterrence, if addressed, has been often added or subsumed under the auspices of deterrence strategies
associated with nuclear weapons. In the second half of the twentieth century, nuclear deterrence dominated geopolitics and national
security strategies. At its height, the threat of mutually assured destruction (MAD) existed in which both superpowers possessed
arsenals with second-strike capabilities, i.e., the ability to respond to a first nuclear strike on land via use of nearly undetectable
submarine-launched ballistic missiles with nuclear warheads.

These historical approaches, however, undermine and oversimplify the distinct challenges of deterring bioterrorism. One such
method attempted is focusing on pathogen security, or securing and denying access to the materials necessary to develop biological
weapons (i.e., deterrence by denial). Based on the nuclear non-proliferation model, pathogen
security strives to control
the materials, equipment, and personnel involved with production and use of biological agents .
With nuclear weapons, controlling fissile materials proved successful because of key characteristics of the critical materials: fissile
material is man-made and can be tracked. Those same characteristics that make nuclear weapons easier to track are those that make
biological weapons material difficult to monitor. These characteristics include the presence of biological agents in nature, lower
production costs, increased diversity of materials that could be used in bioweapons attacks, and multiple legitimate uses for
biological materials. These differing features have not always been fully considered by policy-makers
(1). Rather than focusing solely on securing biological materials and laboratories from misuse, other recommendations and
strategies that the US has pursued include prevention measures such as biosurveillance,
global laboratory and
research cooperation, research and development of diagnostics and countermeasures,
international stockpiles of effective medical countermeasures, and increased response and
mitigation capabilities (2–6). These approaches aim to reduce consequences of an attack, afford
earlier detection, and reduce vulnerability; they do not address the challenge of deterring use and reducing
motivation directly, however.

To date, discussions about public health and deterrence have focused on measures such as regular
vaccinations; access to timely medical care to treat infected, isolate suspected infected, and mitigate the spread of disease;
confidence in the professional nature of health providers, etc. These are largely passive, defensive deterrence
measures, in that they demonstrate credible capacity by a state to respond and mitigate the
consequences of an attack (post-exposure) or reduce vulnerability to an attack by making it ineffective (pre-exposure) (7–
9). Both approaches mentioned thus far, pathogen security and a defensive approach to
terrorism, which ultimately aim to decrease vulnerability by fortifying civilian populations, are
examples of deterrence by denial adapted from the realm of nuclear deterrence.

In contrast to these passive approaches, active deterrence strategies have not been explored. Active
deterrence is actions
and policies preventing a specific opponent from doing something they may wish to do.
Traditionally, robust active deterrence has involved the application of expressive force to change the policy or character of the target
government or group (10). Forces and policies are used to send a political message. In
contrast to passive strategies,
active deterrence is more dynamic and may incorporate escalating threats in response to an
adversary. What this would look like at the nexus of international security and public health is largely an unexplored area of
study or policy. Therefore, there are limited models for thinking about deterrence that have been
developed exclusively for bioterrorism. As a consequence, the role of a robust public health system for twenty-first
century active deterrence remains to be explored. There has not been a substantive consideration of robust public health system as a
strategic asset in a more active deterrence role.

The threat of inflicting punishing retaliation against some aggressor, not the ability to prevent some hostile act from
occurring, is the core of traditional deterrence theory. Within new deterrence approaches in political science,
however, there are several types of definable strategies that may be applied to bioterrorism by foreign actors (11). Indirect
deterrence focuses on third party players and their roles in terrorist attacks. Third parties are most typically state sponsors or
supporting financiers. This concept is based on the recognition that while a terrorist may be willing to die for his cause, it is less
likely that explicit and tacit supporters are willing to pay a similar retribution. Appealing to or directing bioterrorism deterrence
efforts toward tacit supporters is an untapped area. Collective actor deterrence utilizes the power and influence of institutions like
the United Nations, NATO, or other broad coalitions to deter terrorist actions, highlighting the legitimacy of the organization and
the international community rather than the interests of a single state. For bioterrorism, the WHO and African Union’s disease
eradication efforts are examples. Internalized deterrence plays off the psyche of a terrorist, combining abstract concepts of
criminology and social constructivism to subconsciously deter a terrorist through social taboos and norms (12, 13). This might
involve leveraging fear of disease spreading to oneself or one’s own community. Tailored deterrence attempts to individualize each
situation to reach the best possible solution, leveraging cultural, political, social, and other specific knowledge. These newer
deterrence strategies offer opportunities for dealing with bioterrorism threats by foreign actors, which could be combined with
public health information and resources.
In thinking about public health infrastructure as an active or passive part of new deterrence
strategies, it is useful to think about the role of missile defense. As the presence of a ballistic missile defense system is supposed
to be an existential deterrent itself, so could be a strong public health system. Missile defense is both a passive deterrent and, if used,
an active deterrent, as it stops something from occurring. A
strong public health infrastructure is likely to be the
key in reducing the vulnerability to bioterrorism attack, as well as having a potential role in
deterring a foreign terrorist group from even considering such an attack. If a biological weapon
launched by a terrorist group will have little or no effect on the target country because of a known robust
public health sector, then a foreign terrorist may be discouraged from launching a biological weapons attack in
the first place. If foreign terrorists are also aware of the weak public health infrastructure with their own borders, and the increased
risks to them and their publics in the event of an accident in developing biological weapons and/or spread of an infectious disease
that they might launch, this may also deter them from pursuing this work. In addition, even the accidental release of a dangerous
pathogen or the spread of an infectious disease via attack will most likely cause disproportional negative effects to nations with
limited public health infrastructures and affect tacit and explicit supporters in those states.

Extinction
Arturo Casadevall 12, M.D., Ph.D. in Biochemistry from New York University, Leo and Julia
Forchheimer Professor and Chair of the Department of Microbiology and Immunology at Albert
Einstein College of Medicine, former editor of the ASM journal Infection and Immunity, “The
future of biological warfare,” Microbial Biotechnology Volume 5, Issue 5, pages 584–587,
September 2012, http://onlinelibrary.wiley.com/doi/10.1111/j.1751-7915.2012.00340.x/full
In considering the importance of biological warfare as a subject for concern it is worthwhile to review the known
existential threats. At this time this writer can identify at three major existential threats to humanity: (i) large-scale
thermonuclear war followed by a nuclear winter, (ii) a planet killing asteroid impact and (iii) infectious disease. To this
trio might be added climate change making the planet uninhabitable. Of the three existential threats the first is deduced from the
inferred cataclysmic effects of nuclear war. For the second there is geological evidence for the association of asteroid impacts with
massive extinction (Alvarez, 1987). As to an existential threat from microbes recent
decades have provided
unequivocal evidence for the ability of certain pathogens to cause the extinction of entire
species. Although infectious disease has traditionally not been associated with extinction this
view has changed by the finding that a single chytrid fungus was responsible for the extinction
of numerous amphibian species (Daszak et al., 1999; Mendelson et al., 2006). Previously, the view
that infectious diseases were not a cause of extinction was predicated on the notion that many
pathogens required their hosts and that some proportion of the host population was
naturally resistant. However, that calculation does not apply to microbes that are acquired
directly from the environment and have no need for a host, such as the majority of fungal
pathogens. For those types of host–microbe interactions it is possible for the pathogen to kill off every
last member of a species without harm to itself, since it would return to its natural habitat
upon killing its last host. Hence, from the viewpoint of existential threats environmental microbes
could potentially pose a much greater threat to humanity than the known pathogenic microbes, which
number somewhere near 1500 species (Cleaveland et al., 2001; Taylor et al., 2001), especially if some of these species acquired the
capacity for pathogenicity as a consequence of natural evolution or bioengineering.
 2
The plan destroys the economy---cost overruns, and tax hikes
Michael Tanner 17, senior fellow at the Cato Institute. 6/7/17, “Embracing the Hard Realities of
Health-Care Reform” http://www.nationalreview.com/article/448350/health-care-reform-
reality-check-single-payer-model-economically-ruinous
The utopian fantasy of a single-payer system is attractive to many voters, but it would destroy the
American economy.
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 that passed the House last month. 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 last
week 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 copays, 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 ten 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’s 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 U.S. 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 U.S. 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 U.S. 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 U.S. 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’s plan would have reduced the U.S. 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 and 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 that 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.

Global nuclear war

Stein Tønnesson 15, Research Professor, Peace Research Institute Oslo; Leader of East Asia Peace
program, Uppsala University, 2015, “Deterrence, interdependence and Sino–US peace,”
International Area Studies Review, Vol. 18, No. 3, p. 297-311
Several recent works on China and Sino–US relations have made substantial contributions to the current
understanding of how and under what circumstances a combination of nuclear deterrence and
economic interdependence may reduce the risk of war between major powers . At least four conclusions
can be drawn from the review above: first, those who say that interdependence may both inhibit and drive
conflict are right. Interdependence raises the cost of conflict for all sides but asymmetrical or
unbalanced dependencies and negative trade expectations may generate tensions leading to
trade wars among inter-dependent states that in turn increase the risk of military conflict (Copeland,
2015: 1, 14, 437; Roach, 2014). The risk may increase if one of the interdependent countries is governed by an inward-looking socio-
economic coalition (Solingen, 2015); second, the risk of war between China and the US should not just be analysed bilaterally but
include their allies and partners. Third party countries could drag China or the US into confrontation; third, in this context it is of
some comfort that the three main economic powers in Northeast Asia (China, Japan and South Korea) are all deeply integrated
economically through production networks within a global system of trade and finance (Ravenhill, 2014; Yoshimatsu, 2014: 576);
and fourth, decisions for war and peace are taken by very few people, who act on the basis of their
future expectations. International relations theory must be supplemented by foreign policy analysis in order to assess the
value attributed by national decision-makers to economic development and their assessments of risks and opportunities. If
leaders on either side of the Atlantic begin to seriously fear or anticipate their own nation’s
decline then they may blame this on external dependence, appeal to anti-foreign sentiments,
contemplate the use of force to gain respect or credibility, adopt protectionist policies, and ultimately
refuse to be deterred by either nuclear arms or prospects of socioeconomic calamities. Such
a dangerous shift could happen abruptly, i.e. under the instigation of actions by a third party – or against a third
party.

Yet as long as there is both nuclear deterrence and interdependence, the tensions in East Asia are unlikely to escalate to war. As
Chan (2013) says, all states in the region are aware that they cannot count on support from either China or the US if they make
provocative moves. The
greatest risk is not that a territorial dispute leads to war under present circumstances
but that changes in the world economy alter those circumstances in ways that render inter-
state peace more precarious. If China and the US fail to rebalance their financial and trading relations (Roach, 2014) then
a trade war could result, interrupting transnational production networks, provoking social distress, and exacerbating nationalist
emotions. This
could have unforeseen consequences in the field of security, with nuclear deterrence
remaining the only factor to protect the world from Armageddon, and unreliably so.
Deterrence could lose its credibility: one of the two great powers might gamble that the other
yield in a cyber-war or conventional limited war, or third party countries might engage in conflict with each other,
with a view to obliging Washington or Beijing to intervene.
 3
Democrats will win the midterms now by exploiting voter anger over
GOP health care proposals---the plan ensures continued GOP control
Jennifer Rubin 17, Washington Post columnist, 6/21/17, “Will the health-care issue tip 2018 to
the Democrats?,” https://www.washingtonpost.com/blogs/right-turn/wp/2017/06/21/will-the-
health-care-issue-tip-2018-to-the-democrats/?utm_term=.113eabd519d6
While Republican flacks hype the results of the special election in Georgia’s 6th Congressional District and Democrats bemoan a loss
they likely should have expected, we know that the
political landscape will change dramatically between now
and 2018. That’s good news for Democrats and reason for Republicans to avoid sitting back to admire their
victory in a Republican “9.5-plus” district.

As David Wasserman explains: “Last night’s results were far from a disaster for Democrats, and Republicans
shouldn’t be
tempted to believe their House majority is safe. In fact, their majority is still very much at risk.”
For one thing, “unheralded Democratic tax expert Archie Parnell — who ran on a similarly conciliatory, post-partisan message but
generated a tiny fraction of the hype [Jon] Ossoff did — shockingly came within three points of Republican Ralph Norman in a
district President Trump carried by 18 points last November.” Special elections also tend to be “lagging — rather than leading —
indicators,” Wasserman writes. Most important:

If Democrats were to outperform their “generic” share by eight points across the board [as they
have in special elections] in November 2018, they would pick up 80 seats. Of course, that won’t
happen because Republican incumbents will be tougher to dislodge than special election
nominees. But these results fit a pattern that should still worry GOP incumbents everywhere,
regardless of Trump’s national approval rating and the outcome of the healthcare debate in Congress.

Put another way, Democratic

candidates in these elections have won an average of 68 percent of the votes
Hillary Clinton
won in their districts, while Republican candidates have won an average of 54 percent of
Trump’s votes. That’s an enthusiasm gap that big enough to gravely imperil the
Republican majority next November—even if it didn’t show up in “the special election to end all special elections.”
So which significant event(s) might tip the scales even further in Democrats’ direction, and which by
contrast would help Republicans hold on? Republicans need to deliver on health care , taxes and jobs
while also praying that an economic setback or further foreign conflicts do not unsettle the electorate. If you think they can
accomplish all that, then the GOP can rest easy. Of
all of those issues, health care — which Republicans used
to gain majorities in the House and Senate — may be the most decisive because it is the most personal
(and hence most emotional) policy issue. Democrats, by contrast, need evidence that
Republicans cannot govern — or do not govern with voters’ interests in mind.
A good deal of imagination — if not self-delusion — would be required in order to imagine that the Senate can pass its secret health-
care bill and then agree with the House on a bill that can be jammed through via budget reconciliation (which requires a budget).
One has to get really creative to see that the result would be a health-care bill that the country likes.

With each iteration, the GOP health-care plan has gotten worse marks. To that point, Politico reports:

As the GOP-led Senate prepares to take up the measure, only 35 percent of voters surveyed approve of the bill passed by the House
last month. Nearly half of voters, 49 percent, disapprove of the bill. The other 16 percent don’t know or don’t have an opinion, the
poll shows.

POLITICO/Morning Consult polling indicates the bill has become less popular since the House advanced it in early May.
Immediately after the bill passed, slightly more voters approved of the bill, 38 percent. Opposition to the bill was lower, too,
immediately after the House passed it: 44 percent. . . .

Among Republican voters, 30 percent disapprove of the GOP health care bill. That is up from 15 percent of Republicans
disapproving in early May.

Moreover, independent voters disapprove of the bill by a 2-to-1 margin: 26 percent approve, versus 53 percent who disapprove.
Democrats, in other words, will have something in 2018 they don’t have now — a verdict on
Trumpcare. Republicans will either fail to pass something, despite the best efforts of the GOP to use
Medicaid savings to give the rich big tax cuts, or they’ll pass a bill along the lines we have seen . (Leaks from the
Senate negotiations indicate that the cuts to Medicaid could be even more severe in the Senate proposal.) That may take a
generic 8-point advantage for Democrats even higher.
have to govern between now and 2018. Unless they miraculously
In short, Republicans
rethink their agenda and become legislatively adept, Democrats will have
concrete evidence to bolster their argument that the Republicans shouldn’t be left in
control.

Resounding Dem victory’s key to constrain Trump’s impact on the

U.S. democratic model
Ezra Klein 17, Editor-in-Chief, Vox, 2/7/17, “How to stop an autocracy,”
https://www.vox.com/policy-and-politics/2017/2/7/14454370/trump-autocracy-congress-frum
There is nothing about the Trump administration that should threaten America’s system of
government. The Founding Fathers were realistic about the presence and popularity of demagogues. The tendency of political
systems to slip into autocracy weighed heavily on their minds. That power corrupts, and that power can be leveraged to amass more
power, was a familiar idea. The
political system the founders built is designed to withstand these
pressures, and to a large extent, it has.
So why, then, are we surrounded by articles worrying over America’s descent into fascism or
autocracy? There are two reasons, and Trump is, by far, the less dangerous of them.
Trump has shown himself unconcerned with the norms of American democracy . He routinely
proclaims elections rigged, facts false, the media crooked, and his opponents corrupt. During the campaign, he flouted basic
traditions of transparency and threatened to jail his opponent. His tendencies toward nepotism, crony capitalism, and vengeance
unnerve. His oft-stated admiration for authoritarians in other countries — including, but not limited to, Vladimir Putin — speaks to
his yearning for power.

Amid all that, David Frum’s Atlantic cover story, “How to Build an Autocracy,” is a chilling read. “ We are living through
the most dangerous challenge to the free government of the United States that anyone alive
has encountered,” he writes. The argument works because its component parts are so plausible. Frum does not imagine a
coup or a crisis. He does not lean on the deus ex machina of a terrorist attack or a failed assassination attempt. The picture he paints
is not one in which everything is different, but one in which everything is the same.

He imagines a Trumpian autocracy built upon the most ordinary of foundations: a growing
economy, a cynical public, a cowed media, a self-interested business community, and a compliant Republican
Party. The picture resonates because it combines two forces many sense at work — Trump’s will to power and the fecklessness of
the institutions meant to stop him — into one future everyone fears: autocracy in America.

But what Frum imagines is not an autocracy. It is what we might call a partyocracy — a quasi-strongman leader empowered only
because the independently elected legislators from his party empower him. The
crucial sentence in Frum’s account is this
one: "As politics has become polarized, Congress has increasingly become a check only on
presidents of the opposite party."
I am a critic of America’s system of government. For all its genius, I believe it is more fragile, and less sensible, than civics textbooks
admit. I think the profusion of veto points makes governance too difficult, the disproportionate power given to small states is
indefensible, and the absence of any mechanism to resolve conflicts between different branches is dangerous.
But the danger of a demagogic, aspirational autocrat winning the White House is one problem the Madisonian constitutional order
is exquisitely designed to handle. The founders feared charismatic populists, they worried over would-be monarchs, and so they
designed a system of government meant to frustrate them.

The system showed its power this weekend, when Judge James Robart of the Western District of Washington issued a temporary
restraining order freezing enforcement of Trump’s immigrant and refugee ban. Trump raged before the ruling — “if something
happens blame [Robart] and court system,” he tweeted — but his administration complied with it. The spectacle of the president of
the United States seeing his signature program stopped by a district judge in Washington state ruled is a reminder of how many veto
points the system contains.

The judiciary, however, is not the branch of government with the most power or the most responsibility to
curb Trump’s worst instincts. That designation belongs to the US Congress.
The president can do little without Congress’s express permission. He cannot raise money. He cannot declare war. He cannot even
staff his government. If Congress, tomorrow, wanted to compel Trump to release his tax returns, they could. If Congress, tomorrow,
wanted to impeach Trump unless he agreed to turn his assets over to a blind trust, they could. If Congress, tomorrow, wanted to take
Trump’s power to choose who can and cannot enter the country, they could. As Frum writes, “ Congress can protect the
American system from an overbearing president .” He just thinks they won’t.
Frum offers a persuasive account of why congressional Republicans are likely to fall before Trump’s will,
and he is probably right. But I want to make the argument that there
is nothing inevitable about that: it is not
the system envisioned by the Constitution and it is not the system we would have if voters took
Congress’s enormous power seriously and were as interested in who ran it as in who ran the presidency.
And I want to shift the locus of responsibility a bit: if
Trump builds an autocracy, his congressional
enablers will, if anything, be more responsible than him. After all, in amassing power and breaking troublesome
norms, Trump will be doing what the Founders expected. But in letting any president do that, Congress will be violating the role they
were built to play. We need to stop talking so much about what Trump will do and begin speaking in terms of what Congress lets him
do.

Donald Trump is a paper tiger. But the US Congress is a tiger that we pretend is made of paper. It
is, at this point, taken for
granted that congressional Republicans will protect their co-partisan at any cost . It is, at this point,
expected that they will confirm Trump’s unqualified nominees, ignore his obvious conflicts of interest, overlook his dangerous
comments, and rationalize his worst behavior.

That expectation — and the cowardice it permits — is the real danger to American democracy.
How the founders failed

The framers of the Constitution were not infallible, and they were particularly wrong about a core feature of the government they built: They designed the American political
system believing it would, uniquely, resist the creation and influence of political parties. It did not.

In his farewell address, George Washington warned, “The alternate domination of one faction over another, sharpened by the spirit of revenge, natural to party dissension,
which in different ages and countries has perpetrated the most horrid enormities, is itself a frightful despotism.”

But even there, the cracks in the system showed. Washington’s warning against the dangers of parties was, in truth, an argument for the supremacy of his chosen political party.
Rather than the alternate domination of one faction over the other, he sought the sustained domination of his Federalist faction over all others. As historian Sean Wilentz has
argued, it was a “highly partisan appeal delivered as an attack on partisanship and on the low demagogues who fomented it. Washington’s address never explicitly mentioned
Jefferson or his supporters, but its unvarnished attack on organized political opposition was plainly directed against them.”

The framers’ mistaken belief that America’s political system would resist organized parties was consequential. Their vision of American government — a vision children are still
taught in civics classes — was that it would be balanced by competition among branches. The president, the courts, and the Congress would compete for power and prestige.
They would check each other naturally, as a byproduct of exerting and protecting their authority.

The reality of American government today is quite different. American politics is balanced by organized political parties competing across branches of government. The
president is checked not by Congress, but by the opposition party in Congress. The courts remain more independent — Judge Robart, it’s worth noting, was appointed by
President George W. Bush — but they are by no means untouched by partisan competition. Federal judges are selected through a political process driven by organized ideological
groups that vet candidates with the goal of ensuring predictable, friendly rulings in the future.

In normal times, this works well enough. These are not normal times. Congressional Republicans find themselves,
or at least feel themselves, yoked to Donald Trump — an abnormal president who hijacked their primary system and
mounted a hostile takeover of their party. Trump now holds them hostage: Their legislation requires his signature, their reelection
requires his popularity, and he is willing to withhold both.

And so the institution meant to check the president now finds itself protecting him. As Frum perceptively writes:
A scandal involving the president could likewise wreck everything that Republican congressional leaders have waited years to
accomplish. However deftly they manage everything else, they cannot prevent such a scandal. But there is one thing they can do:
their utmost not to find out about it.

But an absence of incentive should not be confused with an absence of responsibility. Trump does not, himself, have the
power to reinforce his rule with a web of corruption . Trump does not, himself, have the power to launch
fraudulent investigations of nonexistent voter fraud and then use the results to disenfranchise voters. Trump does not,
himself, have the power to confirm his Cabinet while refusing to put his assets into a blind trust . In these
cases, and others, Trump’s power exists at the pleasure of Congress . He can only do what they let him
do.

That Congress is not using its power is Congress’s fault, not Trump’s. Whatever danger Trump
poses to the system is their fault as much or more than his — it is their job, after all, to check an out-of-control president.
To put it differently, Trump deserves a bit less attention, and Rep. Jason Chaffetz deserves a lot more.

A case study of congressional abdication: Jason Chaffetz

Jason Chaffetz, the Utah Republican who chairs the House Oversight Committee, is an eager investigator. He’s dug into Benghazi, Planned Parenthood, and Hillary Clinton’s
emails. And he was no fan of Trump’s. “I can no longer in good conscience endorse this person for president,” he said shortly after the Access Hollywood tapes were released.
The reason, he explained, was that he had a 15-year-old daughter, and he could not look in her the eye and defend what Trump said about women.

Like other Republicans, Chaffetz ultimately decided that beating Hillary Clinton was worth overlooking Trump’s transgressions, and he returned, reluctantly, to the fold. But like
other Republicans, Chaffetz expected Clinton to win the election. And he was ready. “Even before we get to Day One, we’ve got two years’ worth of material already lined up,” he
said in October. So that was Chaffetz weeks before the 2016 election — ready to launch a years-long investigation into the next president over email server management.

Last week, Chaffetz released the House Oversight Committee’s agenda for the next two years. It lists 43 items — none of which involve Donald Trump. Actually, that’s not quite
right. Chaffetz does intend to investigate the Office of Government Ethics, which Republicans believe has been too outspoken in its concern over Trump’s conflicts of interest.

So here, then, is Chaffetz after the 2016 election: planning investigations into those raising the alarm over Trump’s conflicts of interest, rather than actually investigating
Trump’s conflicts of interest.

There are obvious reasons for this. The danger for a House Republican in investigating Trump is that he’ll find something, and that something will be used by Democrats to win
back Congress and, ultimately, the White House. Chaffetz is also ambitious to move up in his party — he ran for speaker of the House after John Boehner stepped down in 2015,
and he knows that an overzealous investigation of a Republican president that puts both the Republican majority and conservative legislation at risk will doom his chances of
future advancement.

The Salt Lake City Tribune was appalled. “All that stuff about the constitutional separation of powers, each of the three branches of government keeping a wary eye on the other
two, doesn't mean very much if it is taken seriously only when Congress and the White House are held by different parties,” they wrote. The end of their editorial is worth
quoting, and considering:

The Constitution assumes that human nature will push officials of each branch of government to jealously guard their own powers, creating a balance that prevents anyone
getting up to too much mischief. But when elected officials are less interested in protecting their institution than in toeing the party line, it all falls apart.

It is Chaffetz’s job, more than it is anyone else’s, to hold Trump accountable, to demand that he govern in a transparent and ethical manner. And he has the power to do it. He
can subpoena administration officials and Trump’s business associates. He can make sure the media and the public have much of the information Trump refuses to release, and
he can make it costly for Trump to abandon longstanding norms around transparency, divestment, and governance. The American political system is prepared for the sort of
challenge Trump represents, and there are corrective powers in place.

But the
wielder of those corrective powers must want to use them. And Chaffetz doesn’t. His identity as
a Republican supersedes his identity as chair of the House Oversight Committee , or
even as congressman from Utah’s third district.

This, and not Trump, is what poses a threat to American democracy . Here, in miniature, you can see the
problem we face: not a president who can’t be checked, but a president whose co-partisans don’t want to check him.

Partyocracy, not autocracy, is the danger. It is the danger now, and it is the danger in the future, when the
presidency might be held by a would-be strongman smoother and cleverer than Trump.

Trump’s bluster shouldn’t distract from Congress’s power

American politics is covered like an episode of The West Wing: The president is the main character, his top aides are the supporting
cast, and Congress acts and reacts in the background. But the reality is much the reverse: Congress
holds the bulk of the
power, and the president and his aides must act and react in response to its whims. Trump can only pass the bills
Congress sends him, he can only staff his government with the nominees they confirm, and even
his executive actions routinely rely on authority Congress has handed over and could, at any
point, wrench back. The president is weak but public; Congress is strong but often ignored.
Congress is also a much more accountable institution than the White House. It is closer to the people it represents and more
sensitive to their frustrations. Every
member of the House of Representatives is up for reelection in 2018 — and
if they believe their constituents want more out of them than to act as a blank check for
Trumpism, then more will be given. Already, there are signs that simply protecting the president may not prove
popular:

A recent poll by The Salt Lake Tribune and Hinckley Institute of Politics surveyed more than 600 voters, finding that 65 percent
were in favor of Chaffetz investigating Trump's conflicts of interest, while 31 percent were opposed, the Tribune reported.

It’s worth noting that there are 24

districts held by Republicans that voted for Clinton. If Democrats won
every one of those seats, they would take back control of the House. Congressional
Republicans know they cannot simply ignore public opinion. What they are hoping is that public
opinion ignores them — that those who are worried by Trump’s behavior disengage until
2020, thinking that there are no real remedies until the next presidential election.
The problem America faces right now isn’t what Donald Trump will do, but what Republicans in
Congress will let him do. That is an unintuitive way to think in a polity that obsesses over the president’s every tweet
but barely shows up to vote in midterm elections. But it’s the reality.

This task is as urgent for Republicans as for Democrats — perhaps more so. In part, that’s true for reasons of legacy. The history
books will not speak fondly of Paul Ryan’s tax reforms if their cost was a presidency under which corruption flourished and crucial
norms of governance and transparency were abandoned.

But more optimistically, this is, for Republicans, a moment of opportunity. Nothing about the Trump administration is fixed. Few of
his Cabinet officials have been confirmed. Few of his priorities have been chosen. Little about his relationship with Congress has
been set. Both sides are feeling the other out. This is the point when they can set his presidency on a course that is safer both for
them and for the country.

Given Trump’s inexperience in government, it matters greatly what rules he believes

himself to be operating under. If he can’t act unethically at an acceptable cost, he won’t. If
he can’t confirm unqualified nominees, he will instead be forced to surround himself with qualified nominees. If he can’t govern
without actually cutting himself off from his businesses, he will cut himself off from his businesses or hand the presidency over to
Mike Pence, whom Republicans prefer anyway. If Trump’s worst instincts are curbed early, it makes it more likely that Republicans
will pass their policies, and less likely they are eventually engulfed by scandal or incompetence emanating from the White House.

But if Republicans in Congress abandon their constitutional role to protect their partisan interests, then they must be held no less
accountable than Trump.

There is much talk of the resistance to the Trump administration, and many protests happening outside the White House. But it is in
Congress members’ districts — at their town halls, in their offices, at their coffee shops — where this fight will be won or lost. This is
why it matters that the anti-Trump movement has begun adopting the tactics the Tea Party used to great success against President
Obama in 2010: Those tactics focused on congressional offices, and that’s why they worked.

They are working for liberals, too. Already, congressional Republicans are complaining that their phone lines are jammed, that their
town halls are swarmed, that protesters are, as Rep. Dave Brat said, “in my grill no matter where I go.” And already, congressional
Republicans are beginning to slow down on repealing Obamacare and peel off from Trump’s most unqualified nominees, like Betsy
DeVos.

But this
is the beginning, not the end, of Trump’s opposition seeing Congress as the core
battleground. The real test will be in 2018 — Democratic turnout tends to plummet in
midterm elections, and overall turnout was historically low in 2014. The result, as political scientist Seth Masket writes, is
that Republicans are more afraid of their primary voters than general election voters. Their
behavior will change if and when that changes.
And that should change. It should change in 2018, and it should change thereafter. Congress is more powerful than
the president. It comes first in the Constitution for a reason. The public should demand more of it, and care more who runs it.

crucial question — the question on which much of American

But for now, the
democracy hinges — is not what Trump does. It is what Congress does. The danger posed by
Trump is one that America’s political system is built to protect against. But the officials charged with its protection need to take their
role seriously.

In the end, it is as simple as this: The way to stop an autocracy is to have Congress do its damn
job.

Shoring up the U.S. democratic model’s key to all aspects of U.S.

leadership and global liberal norms
James Traub 17, Fellow at the Center on International Cooperation, 1/3/17, “Donald Trump:
Making the World Safe for Dictators,” http://foreignpolicy.com/2017/01/03/donald-trump-is-
making-the-world-safe-for-dictators/
On April 2, 1917, in the course of a speech asking Congress to declare war on Germany, Woodrow Wilson delivered one of the most
resonant lines in the history of the presidency: “The world must be made safe for democracy.” A generation later, Franklin D.
Roosevelt and Winston Churchill issued the Atlantic Charter, committing the World War II allies to protect “the right of all peoples
to choose the form of government under which they will live.” Since then, all U.S. presidents have insisted that America’s
national security depends upon the spread of democracy and individual rights abroad.
But Donald Trump, who will take office on the centenary of Wilson’s famous address, may be the first president since
America became a world power who simply does not believe that. We should tremble for the
consequences.
The president-elect’s unstinting and often ugly attacks
on journalists, critics, and political opponents show
clearly enough his contempt for democratic norms. He has demonstrated zero regard for such principles of
international law as the obligation to accept refugees, or to refrain from the use of torture. His interest in democratic rights abroad is
even more negligible. The foreign leaders he has most consistently praised, including Russia’s Vladimir Putin, Turkey’s Recep Tayyip
Erdogan, and Egypt’s Abdel Fattah el-Sisi, are strongmen who put their critics in jail, and sometimes in the grave. Trump is already
such a pal of Sisi that he was both willing and able to persuade him last week to drop a Security Council resolution condemning
Israel’s ongoing settlement building.

Trump has now nominated or appointed the key members of his national security team. National Security Advisor Michael Flynn
and Defense Secretary-designate James Mattis are retired generals, while Trump’s choice for secretary of state, Rex Tillerson, is the
chief executive of a giant oil company. Any of these three (and especially Mattis) may prove sympathetic to the Wilsonian claim, but
their experience has taught them to pay far more attention to the military and economic strategy of foreign leaders than to the
domestic political arrangements those men fostered. None of them may be prepared to hinder Trump’s intuitive fondness –perhaps
“envy” is the right word — for dictators.

This really would be something new in American life. Both the neocons who supported George W. Bush’s Freedom Agenda and the
advocates of Barack Obama’s far more chastened rhetoric of long-term institution-building have much more in common with one
another than with the coldly transactional mentality that may guide the Trump administration. As Henry Kissinger wrote in
Diplomacy, we are all (except perhaps Kissinger himself) children of Wilson. All but the most hardened realists accept the premise
that it is in the interests of the United States to shape a better life for people in other countries, even if
they disagree about which instruments to use and how effective they are likely to be.

Some skeptics of America’s self-assigned global mission of reform, like the diplomat-scholar George Kennan, have argued
that the United States will serve its interests better by practicing democracy at home than by
promoting it abroad. That may be so; but it’s not a proposition that a President Trump — with his
nonchalance toward the First Amendment and his newfound devotion to the Second, as well as his steady promotion of crackpot
theories and outright lies on Twitter — is
likely to test. In all likelihood, the United States in years to come will
neither seek to incarnate nor to inculcate the virtues of democracy.
Why should the United States want to “make the world safe for democracy”? Wilson believed that autocratic governments, guided by
the selfish interests of leaders rather than the wishes of citizens, would destroy efforts to establish a “concert for peace” such as he
envisioned. Only democracies would “keep faith” with one another. Subsequent history may have shown Wilson’s faith to be naive,
but it has not discredited the premise that democracies will make
more law-abiding and peace-loving
custodians of the world order than will dictatorships.
A generation of Cold War leaders believed that democracy and broadly diffused prosperity offered the only secure bulwarks against
communism. Presidents from Harry Truman to Ronald Reagan may have contradicted their expressed principles by backing anti-
Communist dictators; but they were right that a democratic Europe would resist the ideological appeal of communism. Today, in the
face of terrorism, the United States makes common cause with Middle Eastern autocrats in Saudi Arabia, Bahrain, and elsewhere,
but nevertheless sees the diffusion of democracy and the rule of law as the best long-term cure for the problem. In the aftermath of
9/11, George W. Bush for the first time elevated democracy promotion to a core national-security interest, insisting that “the survival
of liberty in our land increasingly depends on the success of liberty in other lands.” That, too, miscarried; but the premise was not
wrong.

Presidents keep returning to these formulations because Wilson

was right about the relationship between
democracy and the modern world order. There’s another reason as well: At least since the end of World War II, the
idea that the United States stands for something more than its own self-interest has
underwritten its claims to world leadership. That idea is the basis of America’s “soft power.”
The Marshall Plan, to take the most famous example, did almost as much for the United States, by enhancing its global prestige, as it
did for its European beneficiaries.

So what happens if we abandon this tradition? The silver lining of Trump’s chilly agnosticism toward
democratic values might be this: No more hypocrisy. The Obama administration has shaken a finger at autocratic allies in the
Middle East without inflicting or even threatening serious consequences, thus offending foreign governments without mitigating
their brutalities. On the other side, Obama has halfheartedly supported Syrian rebels without making any effort to tip the scales of
the horrendous civil war there. Trump will deliver no lectures, and may openly join Syrian President Bashar al-Assad in his alleged
campaign against Islamic extremism. Honesty bought at such a price, however, is a commodity not worth having.

President Trump might well feel more comfortable with the increasingly illiberal states of Eastern Europe — including Russia, the
fountainhead of anti-liberal doctrine — than with the social democratic West. One can all too easily imagine him launching a
fusillade of tweets at Atlantic allies who stubbornly persist in using the language of universal rights, including German Chancellor
Angela Merkel, who not-so-subtly warned the incoming president to abide by Western values. How long will it be, in fact, before
“Western values” can no longer be used as a taken-for-granted synonym for secularism, individual freedom, or tolerance for diverse
opinion?

But there’s a more subtle consequence to forswearing America’s traditional moral claims about its global role. The
United States
is able to serve as honest broker in disputes all over the world because it is not seen, as for
example China is, as a prop to existing regimes, however odious. Thus the Obama administration’s patient diplomacy in
Myanmar has given the United States influence with both new democratic leaders and the former military regime. What
happens if any of Trump’s favorite strongmen are overthrown or, God help them, voted out of office? What
influence will Washington have with the successor regime? How, more broadly, will America
compete with China’s growing soft power, or even Russia’s?
Putin’s greatest windfall in recent years has not been his stealth conquest of Crimea or winning the war in Syria for
Assad, but rather the growing eclipse of liberal values across the West. Trump’s election is
a crucial part of that bounty. (It seems increasingly clear that Putin deserves some credit for that outcome thanks to
Russia’s hacking of damaging emails from Democratic Party leaders.) The prestige of liberal democracy has not sunk so low since the
It is a
1930s. Anti-liberal parties lead the polls in much of Western Europe and now govern in Hungary, Poland, and Slovakia.
matter of greater urgency today than it was after 9/11, that the United States act as a beacon of, and
spokesman for, democracy. Yet under a President Trump it will cede that role. Who will inherit it?
Germany, perhaps. But Merkel, gravely weakened by her open-door policy toward refugees, may well lose her bid to return as
chancellor in September. In any case, Germany is a lesser power that in any case has very strong historical reasons for speaking
softly and modestly.

If the United States does not lead in the promotion of democratic and liberal principles, as it has for the
last century, no one else will. And that vacuum will be filled by someone else whose values are
neither democratic nor liberal. Donald Trump’s promise to make American great again will have
descended to tragic farce.
Extinction
Chas W. Freeman 17, served in the United States Foreign Service, the State and Defense
Departments in many different capacities over the course of thirty years, past president of the
Middle East Policy Council, co-chair of the U.S. China Policy Foundation and a Lifetime Director
of the Atlantic Council, 3/9/17, “Reimagining Great Power Relations,”
http://www.unc.edu/depts/diplomat/item/2017/0106/ca/freeman_greatpower.html
Across the globe, the lessened security that results from the erosion of rule-bound order has been
compounded by hysteria over attacks by terrorists. The spread of Islamophobia has paved the way for the revival of other forms of
xenophobia, like racism and anti-Semitism. Illiberalism
looks like the wave of the future. We are
witnessing the consolidation of national security-obsessed garrison states .
Some sub-global powers—like Iran, Turkey, Russia, and China—are demanding deference to their
power by the countries in their "near abroad" or "near seas." They thus negate the near-universal sphere of influence that America
asserted during the so-called "unipolar moment" of worldwide U.S. hegemony that followed the Cold War. They are imposing their
own military precautionary zones ("cordons sanitaires") to manage and reduce external threats from other powers. This pushback is
resented by the United States, which— with no sense of irony, given its own insistence on exclusive control of the Americas—charges
them with attempts to project illegitimate "spheres of influence" beyond their borders.

By disavowing longstanding U.S. commitments, the Trump administration has inadvertently confirmed
foreign doubts about American reliability. Efforts to allay these concerns have garnered little credence.
The ebb of U.S. influence is forcing countries previously dependent on Washington's protection to make
unwelcome choices between diversifying their international relationships, decoupling their foreign policies from America's,
forming their own ententes and coalitions to buttress deterrence, or accommodating more powerful neighbors. Whatever mix of
actions they choose, they also boost spending to build more impressive armed forces.

Almost all countries still under U.S. protection continue to affirm their alliance with the United States even as they ramp up a
capacity to go it alone. Arms races are becoming the norm in most regions of the world. Global military expenditures grew by fifty
percent from 2001 to 2015.

the political
Not long ago, geopolitics was largely explicable in bipolar terms of US-Soviet rivalry. After a unipolar moment,
and economic orders have gone fractal—understandable only in terms of evolving complexities at the regional or sub-
regional level. Intra-regional rivalries now fuel huge purchases by middle-ranking powers of state-of-the-art weaponry produced by
the great powers. No one should confuse increased weapons purchases with a deepening of alliance commitments.

So, for example, Saudi Arabia's arms purchases have tripled in the past five years. Trends in other Gulf Cooperation Council (GCC) member countries are similar. At the same
time, the Gulf Arabs are reaching out to China, the EU, India, Indonesia, Japan, Russia, and Turkey and convening pan-Muslim coalitions against Islamist terrorism and Iran.
They have undertaken unprecedentedly unilateral and aggressive military interventions in places like Libya, Syria, and Yemen. As they have done so, the countries of the Fertile
Crescent—Iraq, Lebanon, and Syria—have drawn ever closer to Iran. Iraqi Kurdistan has become a de facto Turkish dependency.

Before a Western-supported coup ousted Ukraine's elected president2, that country wobbled between East and West but was on its way into the Russian embrace. The
Philippines has distanced it from the United States and bundled with China. So has Thailand. Myanmar and Vietnam, by contrast, are seeking partners to balance China. The
Baltic states of Estonia, Latvia, and Lithuania have doubled down on their reliance on NATO, which they joined in 2004 to secure their independence from Russia. Cuba and
Venezuela look to Russia and China for support against ongoing American policies of regime change.

Meanwhile, international governance of trade and investment continues to devolve to the regional level and configure itself to supply chains. Examples include new trade pacts,
like the RCEP,3 the Pacific Alliance,4 and the Eurasian Economic Union;5 preexisting blocs like the GCC,6 Mercosur,7 and the Shanghai Cooperation Organization;8 as well as
well-established confederations like the 27-member post-Brexit EU and the Economic Community of West African States (ECOWAS)9 . Each of these groupings has one or two
heavyweight members at its core, constituting a natural leadership.

Where such regional arrangements have been implemented, rules are made and enforced without much, if any, reference to external powers. Thus, the EU has had no role to
speak of in shaping relations between Canada, Mexico, and the United States under the North American Free Trade Agreement (NAFTA). Conversely, the United States has had
very little say in decisions made in Brussels on rules for trade and investment in the EU and its associated economies. Given the Trump administration's aversion to
multilateralism, the United States will have no say at all in the standard-setting that will take place in either the RCEP or the 65-country pan-Eurasian economic community that
is beginning to emerge from China's "belt and road" initiative. Regionalism limits the reach of great powers. Bilateralism limits it even more.

The decentralization of authority over global economic, political, and defense issues represents a net loss of influence by the U.S. and other great powers over the evolution of the
international state system. But it presents both a challenge and an opportunity for middle-ranking powers. On the one hand, as U.S. and EU influence atrophies, they have an
expanding role in international rule-making. On the other, they are now subject to pressure from neighboring great powers that is unmoderated by any global rules.

Take Mexico as an example. This is a proud nation of nearly 130 million people, the world's 13th largest country geographically and its 11th most populous. It has the world's 11th
largest economy. By every measure, Mexico is a middle-ranking power. As such, even if it were not a member of NAFTA and the Pacific Alliance, it would have a significant voice
in the G-20, the WTO, the United Nations, Latin America, the Caribbean, and the Asia-Pacific.

Interdependence has mitigated but not erased historic Mexican resentment of domineering American behavior. Mexicans have not forgotten that the United States invaded their
country and annexed 55 percent of its territory in 1846–1848. But, since the entry into force of NAFTA in January 1994, Mexico's economy has become almost fully integrated
with the American economy through complex supply chains. Eighty percent of Mexican exports now go to the U.S. Mexico has become the United States' second largest export
market and its third largest trading partner (after China and Canada). It has also quietly transformed itself into a reliably pro-American bulwark against influences from extra-
hemispheric powers like Russia and China. It has proven the efficacy of economic opening and reform and has become an influential advocate of liberal economics as opposed to
the perennial statism and mercantilism of most other Latin American nations.

Now Mexico is faced with demands from the Trump administration to cooperate in dismantling its interdependence with the United States. At the same time, the U.S. president
is denigrating Mexicans, proposing to wall them out, and threatening to deport masses of undocumented migrants and alleged criminals to Mexico, whether they are Mexican or
not and whether Mexico has any legal reason to accept them or not. Not surprisingly, Mexican opinion is now hostile to the United States. Mexico's government has little leeway
for compromise. Surrender to American demands is not an option. But Mexico currently has little leverage over Washington.

So Mexico faces highly unwelcome choices. It can bargain as best it can on its own, risking its prosperity and stability on what is almost certainly a bad bet. It can seek leverage
over the United States by suspending cooperation against transit by illegal migrants and the supply of narcotics to American addicts. It can make common cause against the
United States by forming a global united front with other economies targeted by the Trump administration for their bilateral trade surpluses, like China, Germany, Japan, and
south Korea. It can adopt Cuban-style defiance of Washington's efforts to bring it to heel, allying itself with extra-hemispheric powers like China and/or Russia or Iran. Or it
could choose some mixture of all of these options. It is too early to predict what course Mexican-American relations will take in the age of Trump. They will be affected by many
factors, including the state of relations between the United States and other great powers – especially China and Russia.

Mexico is far from the only middle-ranking power now of necessity maneuvering between the world's great powers. Ukraine has yet to find its place between Russia, the EU, and

Turkey has distanced itself from the EU and America and formed an entente (limited
the United States.

partnership for limited purposes) with

Russia. Iran has reached out to India as well as Russia in order to
counter the United States and the Gulf Arabs. Saudi Arabia—once exclusively attached to the United States—is actively
courting China, India, Indonesia, Japan, and Russia. Pakistan is seeking to avoid having to choose between Saudi
Arabia and Iran. At the same time, it has accepted the task of coordinating the activities of a pan-Islamic military alliance that
implicitly counters both Iran and an ever more assertively Islamophobic India. To reduce dependence on the United States and the
GCC, Egypt
is courting cooperation with Iran, Russia, and Turkey. Old global alignments are
everywhere giving way to more complex patterns.
Despite an unprecedented degree of interdependence between them, relations between the great
powers are also in motion. Brazil, China, the EU, India, Japan, Russia, and the United States are each one another's
largest or second largest trading partners and sources of foreign direct investment. They are linked to each other in global supply
chains, which tend to converge in and between large economies. All are members of the Bretton Woods legacy institutions – the
International Monetary Fund (IMF), World Bank, and WTO. These institutions earlier accommodated the rise of Japan. More
recently, they have lagged in reflecting the rapidly increasing weight of other non-Western economies in world trade and finance.

The formation of the "BRICS" group was a collective effort by Brazil, Russia, India, and China (soon joined by South Africa) to
develop institutions to reflect the current distribution of global commercial and financial power and contemporary governance
requirements. When Bretton Woods took place the world had just been crushed by World War II. America dominated the world
economy, justifying its preeminent role in global governance. Recent shifts in economic balances of power have not been reflected in
legacy institutions. Washington remains the nominal leader in them but finds itself increasingly sidelined as others feel obliged to
work around it. The Trump administration's skepticism about the value of the international economic institutions that earlier
generations of Americans created has accelerated the diminishment of U.S. managerial control over the global economy.

Similar erosion of U.S. primacy is evident in international politics. China, India, and Russia have met annually since 2002 to discuss
how to establish a multipolar world order in which U.S. unilateralism cannot hold sway. Antagonism between the
world's greatest powers is growing. With the United States pushing back against Russia in the West and China in the
East, the two are being nudged together to counter America.

To offset Sino-Russian partnership, Japan seeks rapprochement with India and Russia, leavening its longstanding exclusive reliance
on the United States. China, Europe, Russia, and the United States are also courting India, which is, as always, playing hard to get.
Meanwhile, China is reaching out to Europe and the EU is attempting to work with it to fill the leadership vacuum in the Asia-Pacific
created by the sudden U.S. abandonment of the economic leg of its "pivot to Asia." No
region is immune from
realignment in its international relationships. Brazil's membership in the BRICS group symbolizes its cultivation of
relationships with emerging powers to balance those it has with the United States and middle-ranking powers in the Western
Hemisphere.

As a consequence of these trends, we are now well into a world of many competing power centers
and regional balances. Long-term vision and short-term diplomatic agility are at a premium. Neither is anywhere
evident. In their absence, territorial disputes rooted in World War II and Cold War troop movements and lines of control,
arms races (nuclear as well as conventional), shifting balances of prestige, and the
reduced moderating effect of international organizations are helping to escalate alienation
and tension between the great powers.
The stakes are high. Trade wars that could wreck the global economy and degrade the
prosperity of all are now all too easy to imagine. Armed conflict could break out at any time
along the unsettled borders between China and India and China and Japan. The U.S. and Chinese navies
are maneuvering against each other in the South China Sea. The two countries appear to be headed for a military
confrontation over Taiwan. The Peloponnesian War and World War I remind us that squabbles between lesser powers
can drag their patrons into existential strife despite their better judgment.
Notwithstanding ample opportunity to do so, the U.S., EU, and Russia failed to craft a cooperative post-Cold War order to regulate
their interaction in Europe. There is no agreement on where NATO ends and Russia begins. We now face the possibility that it will
take an armed face-down to define a dividing line between them.

All great powers now share an avowed interest in containing Islamist terrorism and remediating its causes. Escalating antipathies
born of territorial disputes and Chinese and Russian opposition to U.S. primacy prevent cooperation to this end. The politically
expedient demonization of strategic rivals in democracies like the United States inhibits cooperation even where specific interests
nearly completely coincide. The same factors diminish the likelihood of cooperation on other matters where interests substantially
overlap —like Syria and Korea.

Meanwhile, U.S. deployments of ballistic missile defenses and the increasing lethality of American nuclear warheads have convinced
both Russia and China that Washington is reaching for the ability to decapitate them in a first strike. Russia and the United States
are in a nuclear arms race again. China seems to have been provoked to develop a second-strike capability that, like Russia's, will be
able to annihilate, not just maim America. The
Bulletin of the Atomic Scientists has moved its "Doomsday
Clock" the closest to midnight since 1954.
The risks the world now faces were not (and are not) inevitable. They are the product of lapses of
statesmanship and failures to consider how others see and react to us. The setbacks to America's ability to shape
the international environment to its advantage are not the result of declining capacity on its
part. They are the consequence of a failure to adapt to new realities and shifting power balances.
Raging against change will not halt it. Pulling down the frameworks and trashing the rules on which North
American and global prosperity were built is far more likely to prove counterproductive than
empowering. Buying more military hardware will not remedy the national strategy deficit. Gutting the foreign affairs agencies and
doubling down on diplomacy-free foreign policy will deepen it.

Americans are badly in need of a national conversation about their aspirations in foreign affairs and how to
take advantage of the changing world order to realize them. That conversation did not take place
during the run-up to the 2016 election. The inauguration did not mark an end to the chaos of
the presidential transition. Forty-eight days later, most government policy positions remain unfilled. Policy
processes have yet to be defined.

In the current atmosphere, slogans displace considered judgments, intelligence about the outside world is unwelcome, expertise is
dismissed as irrelevant or worse, and policy pronouncements appease the delusions of political constituencies instead of addressing
verifiable realities. The Congress has walked off the job. Some sort of order must eventually
reassert itself in the U.S. government, but the prospects for intelligent dialogue about the implications for
American interests of developments abroad seem exceptionally poor.

But such dialogue cannot be deferred for another four years. It seems ever clearer that it will not
originate in Washington. It must begin somewhere. Why not here? Why not now?
 4
The fifty states and relevant subnational territories of the United
States should establish state wide health insurance exchanges
State action is key even if federal reforms are preferable---key to solve
geographic coverage gaps and leads to federal follow on
Henry Aaron 8, Bruce and Virginia MacLaury Senior Fellow at the Brookings Institution,
Economic Studies, written with Stuart Butler, vice president, Domestic and Economic Policy
Studies, at the Heritage Foundation, May 2008, "A Federalist Approach To Health Reform: The
Worst Way, Except For All The Others," Health Affairs, Volume 27, Number 3, May 2008, pp.
725-735

Support for state action should be part of any strategy to expand health insurance
coverage. Decades-long political deadlock in Washington has frustrated national efforts to expand coverage. Some states have
already undertaken to do this; others show a determination to do so. Regulatory and legislative
flexibility would trigger widespread state action. Whether one thinks that ensuring coverage
requires a unified national approach or that diverse conditions require different methods in
different states, the likelihood of progress will be advanced if states test out various ways to
expand coverage. We describe a practical way by which the federal government can promote state action to expand health insurance coverage.
Federal encouragement of state health reform will advance both the state and national reform agendas.

HISTORIAN SHELBY FOOTE REMARKED THAT before the Civil War, people commonly wrote, “the United States are…” but that after the war they
wrote, “the United States is….” As far as health care delivery is concerned, the United States remains very much in the “are” phase. Whether and when it
will move to the “is” phase remains highly uncertain. County
and state differences in the organization,
financing, and use of health care are vast. The proportion of uninsured people varies
across states by nearly three to one. Expenditures per person in the highest-spending state
exceed those in the lowest by 70 percent. Use of various services differs among Hospital
Referral Regions (HRRs) by five or ten to one and sometimes more.1 Some of the differences arise from
explicit state policies or income differentials. Some result from historical accident. The simple fact is that for whatever reason,
quality of and access to care are better on average in some states than in others.

differences should not be ignored as the nation strives to reform its health care
These
system. Some people argue that national legislation is imperative to achieve consistent, comprehensive
coverage throughout the country. Others hold that separate action by individual states is the wiser course, given
the U.S. political system and disagreements on the best way forward, even among experts of the same philosophical persuasion. This disagreement is
important, but adherents of both positions should recognize that encouraging state action to expand
coverage at this time will advance both agendas. We argued some time ago in Health Affairs that measures to
energize state experimentation within a federal-state framework based on clear national goals will
achieve two objectives: it will extend coverage in the near term, and it will advance the date at

which coordinated national action is possible.2 Our view has not changed, and it is unlikely
to do so, no matter who wins the next presidential election.

State Reform: The Best Way To Trigger National Action

Each of us continues to favor national action. We both feel that Americans have come to a consensus that access to adequate
basic health
care is part of what it means to be a resident of the United States. That consensus involves important values and goals, and it requires
key
legislative actions at the federal level to set the nation on course to realize those goals. But for three reasons we
believe that a strategy based on state initiatives is likely to be the best way to trigger
national action.
Breaks political deadlocks.
First, there
are deep disagreements among reasonable and committed people—including between us—about what the
best practical approach is. That makes it very difficult to get political support for coherent, workable
action even among those who broadly agree on goals. Our strategy is designed as a political device
to break that deadlock by making it possible to launch a variety of bold approaches quickly,
with the more successful initiatives helping to build consensus for more sweeping action.
Allows for glitches in a limited arena.
Second, given
the complexity of current U.S. health care financing, it is likely that well-intentioned reformers
will make mistakes. Eventual national action will emerge with fewer glitches if those
mistakes are made on the limited stage of individual states than if a full-blown national plan
must be designed in advance.XT
Can accommodate states’ variations.
And third, we believe that any
national system would have to accommodate considerable state-to-
state variation, at least for many years. If that is so, then why not begin with a system that incorporates state
variation as an instrument to spur continuous improvement amid uncertainty and
disagreement about the ideal solution?
 5
Text: The Federal government of the United States should:
1. Create a new interagency entity charged with oversight of biodefense activities at the
federal, state, and local level
2. Request a separate fund to support mobilization in the instance of an attack
3. Increase bio-surveillance capacity
4. Increase medical countermeasures and development
5. Fund additional private-public partnerships and fundamental research related to the
development of antibiotic and antiviral drugs
PCAST 16, President’s Council of Advisors on Science and Technology “Action Needed to
Protect against Biological Attack” , November 2016, Executive Office of the President.
https://obamawhitehouse.archives.gov/sites/default/files/microsites/ostp/PCAST/pcast_biode
fense_letter_report_final.pdf
VIII. PCAST’s Recommendations PCAST divides its recommendations into actions aimed at near-, medium-, and long-term
objectives. In all cases, work should begin now to ensure that the various measures will be in place by the time the Nation needs
them. In addition to the recommendations below, PCAST has made recommendations pertaining to threat awareness in the
classified annex to this letter report. Near-Term Recommendations RECOMMENDATION
1. The President should
create a new interagency entity charged with planning, coordination, and oversight of national
biodefense activities across the Intelligence Community and the Departments of Defense (DoD),
Homeland Security (DHS), Health and Human Services (HHS), and Agriculture . The entity should be
co-led by the Assistant to the President for Homeland Security and Counterterrorism, the Assistant to the President for Science and
Technology, and the Chair of the Domestic Policy Council. The entity should have senior-level representation from all of the
indicated agencies, including from within HHS, the Centers for Disease Control and Prevention (CDC), the Biomedical Advanced
Research Projects Administration (BARDA), and the National Institutes of Health (NIH). The entity should be charged with: a.
Developing, within six months, a national biodefense strategy—including short-, medium-, and long-term
components—to anticipate, prepare for, and respond to all issues that arise as biotechnology
continues to advance; b. Preparing thereafter annual public updates (with a classified annex) to the
President that describe progress toward achieving the strategy and update the strategy as
necessary; c. Overseeing execution of the national biodefense strategy and holding agencies
accountable for progress; d. Guiding requirements and taskings of the Intelligence Community
(IC) and holding the IC accountable for adequate collection and analysis of current and future biological threats to the United States
and for other activities of the IC that might mitigate these threats; and e. Ensuring coordination of efforts against new and emerging
infectious diseases, antibiotic resistance, and intentional biothreats—including through the development of biosurveillance systems
and the new medical-countermeasures.

RECOMMENDATION 2. The President should request that Congress establish a Public Health
Emergency Response Fund of at least $2 billion. The fund would support mobilization of rapid
Federal responses to serious, rapidly emerging natural or intentional infectious-disease events,
including public health interventions (by CDC), scientific research (by BARDA and NIH), regulatory
activities (by FDA), and global response (by DoD, CDC, and the U.S. Agency for International Development). a. The
Emergency Response Fund should, analogously to Federal Emergency Management Agency’s (FEMA) Disaster Relief Fund, consist
of funds that carry over across years and can be replenished by routine and emergency appropriations. b. Access to funds should be
contingent upon the express authorization of the President or the joint agreement of the secretaries of HHS and DHS. Medium-
Term Recommendations RECOMMENDATION 3. As part of its national biodefense strategy, the White
House should act to substantially strengthen Federal, state and local public health infrastructure
for disease surveillance, as well as promote a stronger international system of disease surveillance. The surveillance
capacity should include: a. Laboratory networks in the United States and abroad with the capability for
early detection and rapid monitoring of both human-made and natural emerging infectious
agents in public health, agricultural, and wildlife settings. b. The ability to routinely and rapidly employ
advanced biological tools—including rapid diagnostic tests, large-scale genome sequencing and
analysis, and new approaches to monitor the host immune system—for systematic evaluation of possible cases, including those
presenting simply as “fevers of unknown origin” or “severe acute respiratory infections.” RECOMMENDATION 4. The
White House should set the following ambitious ten-year goals with appropriate funding (of at least
$250 million per year) for medical countermeasures preparedness. The Secretary of Health and Human Services
and the Secretary of Defense should report annually to the White House about progress and impediments to reaching these goals: a.
For infectious organisms for which there exist effective approaches to creating vaccines, the United States should have the ability to
accomplish, within a six-month period, the complete development, manufacture, clinical testing, and licensure of a vaccine. For
pandemic influenza, the goal should be 3 to 4 months to vaccine deployment. b. For infectious organisms that might be reasonably
anticipated to lead to sudden epidemic spread that could threaten the U.S. population or U.S. interests overseas, the United States
should have pre-tested vaccine candidates through safety and immunogenicity studies.

RECOMMENDATION 5. The United States should set as a national priority the identification
and development of additional classes of broad-spectrum antibiotic and antiviral drugs. Building
on progress already made pursuant to the President’s Executive Order on Combating Antibiotic Resistant Bacteria, and the
corresponding National Strategy and National Action Plan, theUnited States should fully implement PCAST’s
recommendations from its 2014 report Combating Antibiotic Resistance related to antibiotic
development, as well as the analogous strategies for antiviral development: a. Expand
fundamental research relevant to developing antibiotics for human healthcare and other
approaches to treating bacterial infections b. Establish a robust national infrastructure to
support clinical trials of new antibiotics c. Strengthen and expand the dedicated existing
regulatory efforts for MCMs and develop new regulatory pathways to evaluate urgently needed
antibiotics; and d. Significantly increase economic incentives for developing urgently needed
antibiotics. The United States should also support the development of platform technologies for rapid production of therapeutics
and preventative medicines (examples include specific immunobiologicals such as engineered antibodies, emerging nanomedicines
that elicit specific and desired immune responses, and chemically modified nucleic acids with peptide adjuvants) to neutralize and
block infectious organisms of natural origin or agents of biological attack. Long-Term Recommendation
RECOMMENDATION 6. The Departments of Defense, Health and Human Services, and other
government agencies should promote vigorous basic and applied research efforts in academic,
industrial and government laboratories with the goal of developing new types of
countermeasures. These countermeasures should be rapidly and easily modified to target, safely
and effectively, specific human-made and naturally-occurring pathogens. The delivery of approved
countermeasures should be within days after the an agent’s detection and characterization. HHS and DoD should receive new
funding of $75M per year for four years to lay the foundation of this initiative. Funding for relevant agencies within HHS and DoD
should then ramp up to a steady-state of at least $250M per year. Examples of such rapid countermeasures might include
approaches that: target infectious agents based on their genomes; employ optimized and tested vectors to deliver other nucleic acid-
based anti-pathogen approaches to a wide range of specific human cell types; activate the immune system against classes of
pathogens; target host pathways required by pathogens; rely on antigens expressed by RNA and nucleic acid analogs to stimulate
protective immunity against specific pathogen epitopes; or provide immunity via antibodies and immune cells engineered to
recognize pathogen-specific epitopes.
 6
The United States federal government should shift health insurance
to a free-market system by:
 Removing regulatory and tax advantages for employer-provided
group health insurance
 Removing regulatory barriers to insurance market competition,
including limits on cross-state competition, mandates affecting
the amount of services covered by insurance, individual and
employer mandates, and mandates that insurers cover
particular groups
 Ending anti-trust exemptions currently applied to health
insurance
 Repealing the Patient Protection and Affordable Care Act
 Reforming tort laws to decrease physician liability, and capping
damages
 Ending hospital certificate of need laws
 Repealing the 3 to 1 premium difference requirement, requiring
states to phase in this repeal over four years
 Providing vouchers for Medicare recipients to participate in
insurance markets
 Subsidizing initial health-status insurance accounts for
individuals with pre-existing conditions. Subsidies should be
phased out as the market evolves and stabilizes.
Solves costs and increases coverage---the aff shuts down competition
and leads to worse health outcomes
Eric Schansberg 11, Professor of Economics at Indiana University Southeast, Ph.D. in Economics,
2011, “Envisioning a Free Market in Health Care,” Cato Journal, Vol. 31, No 1.
Insurance Regulation

Another important area for reform would be three sets of policy proposals that would
dramatically reduce insurance regulation.
First, insurers are often prevented from competing with each other across state lines. Insurance from
out-of-state providers was greatly reduced by the McCarran-Ferguson Act of 1945. The Act followed a 1944 Supreme
Court ruling that insurance was classified as “interstate commerce” and could be regulated by federal antitrust laws. The Act gave
antitrust exemptions to the insurance industry and implicitly codified state insurance
regulations into federal policy. These restrictions need to be eliminated to promote competition ,
increase choice, and reduce costs.
Second, in the current environment, it is very difficult to offer insurance services across state lines because of insurance
mandates that increase the number of services covered by insurance. This requirement results in
higher costs, less flexibility for consumers, and less ability for insurers to compete. A free-
market system would allow people and insurers to make mutually beneficial
arrangements on what insurance would cover.
All 50 states require insurers to either offer or include certain benefits in the insurance policies they offer (Bunce and Wieske 2009).
Some states, for example, require an insurer to include benefits for the treatment of alcoholism or treatment by a chiropractor,
regardless of whether any given person wants those features (Graham 2008b). More broadly, insurance companies are not allowed
to specialize in insurance for specific ailments (e.g., diabetes or cancer).

As a result of these mandates, one finds significant levels of market concentration in the
insurance industry within the states. In 38 states, the largest firm serves more than one-third of
the market and in 16 states more than half. In 47 states, the largest three firms serve more than
half of the market and in 36 states more than 65 percent (Robinson 2004). In 2008, the market
share of the five largest insurers was at least 75 percent in every state (Emmons, Guardado, and
Kane 2008).4
Third, states commonly mandate coverage for certain groups of people, again resulting in higher
costs and cross-subsidies from the healthy to the unhealthy, and from those who plan well for their futures to
those who do not. These restrictions come in a variety of forms. There are “guaranteed issue” mandates that require all insurers to
make insurance available to all applicants regardless of a change in health status. There are also “guaranteed renewal” mandates that
require insurers to renew insurance policies when the policy expires, and mandates to require insurers to cover additional persons—
for example, children up to 25 years of age (King 2009).

In addition, a number of states have substituted “community rating” for “risk rating” (Sloan and Conover 1998). “Strict” community
rating requires an insurer to charge each insured individual the same premium regardless of age, sex, health status, claims
experience, or other risk factors. “Modified” community rating allows an insurer to vary the premium based on age or another of
these factors, but not health status.

Bunce and Wieske (2009) find 2,113

state mandates nationwide on services and providers. Those
mandates are costly to insurers who respond by increasing premiums or leaving the
market, thus reducing competition and driving up prices. Evidence of this is seen in the remarkable cost
differences between similar policies in different states. For example, in 2005, the average individual paid $4,044 in New Jersey and
$3,996 in New York for health insurance, but only $1,188 in Iowa and Wyoming (Matthews 2005). More recently, minimum
coverage for a family of four cost $145 in Iowa versus $906 in Massachusetts (Armey 2009). A healthy 25-yearold male could
purchase a policy for $960 a year in Kentucky but would pay about $5,880 in New Jersey. An average family in Texas paid $5,501 a
year for coverage in 2006–2007, whereas an average family in New Jersey paid $10,398 (Bond 2009).

Parente and Bragdon (2009) report that the proportion of individual plans in New York decreased from 4.7 percent to 0.2 percent
from 1994 to 2007, while the national average increased from 4.5 percent to 5.5 percent. They attribute this to the guaranteed issue
and community rating mandates enacted by New York.

The overall costs of such regulations are even more staggering. Conover (2004) calculates $170
billion in benefits from such regulations but $339 billion in costs, a 2:1 ratio with a net social
loss of $169 billion—which costs the average family of four more than $2,200, enough to
implement the free-market reforms discussed earlier. Conover (2004: 1) further estimates that regulations are “responsible for more
“4,000 more
than seven million Americans lacking health insurance or one in six of the average daily uninsured” and fi nds that
Americans die every year from costs associated with health services regulation (22,000) than
from lack of health insurance (18,000).
The market remedy here is to repeal all of these mandates and allow insurers to freely set rates based on risks. One should note that
some of these regulatory efforts are Band-Aids to deal with unfortunate outcomes in the current health care and health insurance
systems—e.g., pre-existing conditions. As described earlier, a deregulated and unsubsidized insurance environment would take care
of those problems.

Bast (2007) has two policy suggestions worth mentioning. First, he would eliminate the requirement that health insurers pay a very
high proportion of their claims within a certain period of time (see Bunce 2002). Second, as a second-best solution, he argues that
insurers should be allowed to offer temporary or permanent medical waivers for pre-existing conditions (see Wieske and Matthews,
2007).
Federalism
 Crowd-Out---1NC
The public option crowds out private insurance---increases
government costs and premiums, exacerbates cost shifting, and
devastates state budgets
Susan Rupe 16, managing editor for InsuranceNewsNet, citing Michael Keegan, senior vice
president with Health Agents for America, and Diane Boyle, senior vice president of government
relations for the National Association of Insurance and Financial Advisors, 09/15/16, “Public
Option Would Hurt Consumers, Industry, Agent Advocates Say,”
https://insurancenewsnet.com/innarticle/agent-advocates-say-public-option-hurt-consumers-
damage-industry
The public option is back in the discussion about health insurance – and the agent community fears it
would further hamper their ability to serve clients while doing nothing to rein in costs .
The public option – the idea of creating a government-run health insurance plan to compete with existing carriers – has become one
of the Democrats’ draft platform planks as their national convention approaches later this month.

President Barack Obama spoke out in favor of the concept in an article he wrote in the Journal of the American Medical Association,
saying consumers should be able to buy health insurance directly from the government.

Meanwhile, presumptive Democratic presidential candidate Hillary Clinton has said if elected she would work with interested
governors to implement state-based versions of the public option. She also has campaigned in favor of allowing consumers to enroll
in Medicare at age 55.

Public option supporters say a government-run plan would add another element of competition into the health insurance
marketplace and would lower premiums, especially if the government is able to dictate low reimbursement rates to doctors,
hospitals, drugmakers and other medical care suppliers.

But those who represent the agent community told InsuranceNewsNet that a public option actually would
decrease competition rather than increase it, and would hinder consumer access to
professional advice.
“Our concern has always been that a
public option – a government plan – reshapes the playing field and makes
it less of a level playing field for private plans ,” said Michael Keegan, senior vice president with Health
Agents for America. “We’re concerned about consumers’ ability to have plans to choose from. Are you
going to have a marketplace that is geared more toward the government? When government comes in and ends up the big player,
will this crowd out competition? Will this crowd out private insurers? Will consumers have the choices that they would not have
otherwise?”

In addition to pushing out competition from private insurers, another concern raised was the cost
of running a public option. A price tag has not yet been put on a public option, but nearly all discussion of such a
proposal emphasized that the program would have to be self-sustaining.

Keegan pointed to the health insurance exchanges and health insurance co-ops that were established under
the ACA as examples of why a public option would end up costing the government more
money . A number of insurance carriers whose products were sold on the exchanges have cited
enormous financial losses from their ACA business, while 16 of the original 23 co-ops have shut down
because they could not afford to remain in operation.
“Health insurers already have a head start in terms of creating provider networks,” he said. “To be
new entrant in that market really is very difficult. It does require a lot of money if you’re
going to get a robust plan in place and create these networks .”
A public option that is financially self-sustaining “is a great idea in theory but if you want to put it into
practice, I don’t think those numbers will add up,” said Diane Boyle, senior vice president of government relations for the
National Association of Insurance and Financial Advisors. “Would it throw more competition into the mix and drive costs down? If
anything, it
would exacerbate cost shifting and drive prices up . How can it be self-
sustaining? Where does the money come from? Nobody is saying.”
NAIFA President Jules Gaudreau echoed the concerns about cost in a statement in which he said a
public option “ would pose a huge economic drain on states . The potential loss of
millions of insurance-related jobs and billions in annual state premium tax
revenues would be devastating to our already financially strapped state economies .”

Health insurance agents already are struggling with reduced and eliminated commissions from
policies they sell on the exchanges. Throw a public option into the mix, and agents could be squeezed even
further.
“This will further squeeze compensation,” HAFA’s Keegan said. “There is an assumption by some in the state and
federal government that agents are just salespeople. Certainly when you look at what goes into servicing clients, it’s much greater
than that. At what point will agents and brokers even want to stay in this business? If agents and brokers leave,
consumers will be hurt.”
At NAIFA, Boyle said part of what is fueling the public option discussion is the perception that agent commissions are driving up the
cost of health insurance. “What is missed is the value that the agent brings to the system,” she said. “How do you replace that
service? How do you get access to a professional who offers guidance?”

Would a public option go so far as to eliminate health insurance agents altogether ? Boyle said it
depends on how the option is structured. “The devil is in the details,” she said. “Look at the exchanges. When they were first
proposed, the question was would the exchanges put agents out of business? Depending on how they’re designed,
absolutely they could.”
Boyle said she doesn’t believe the public option will gain momentum, “but if it does, do we step in and ask if there is a role for the
agent within that structure? The need for access to professional advice even in a government-run plan is going to be necessary. How
is the government-run plan going to enroll individuals, how is it going to provide consumers with access to advice? Even in that
scenario, could there still be a role for the agent? Will it be a meaningful, fairly compensated role? Probably not."

The National Association of Health Underwriters is dusting off the position paper it issued against the public option back in 2009
and updating it as it prepares to do battle against the proposal again. In that position paper, NAHU cautioned that a government-
run option would lead to unequal competition and long-term market damage.

“Since the public plans reimburse providers at lower rates and account for other administrative
costs differently, the playing field would never truly be level . For example, private health
insurers pay providers up front while Medicare merely reimburses them based on what
Medicare is willing to pay out for any given procedure,” the NAHU paper said.
“Itis a fundamental insurance principle that unequal competition in the market over time will
lead to adverse selection and long-term market damage .”
NAHU also is concerned about the cost impact a public plan option will have on all Americans.

“IfCongress creates a public health plan option for the under-65 population, privately insured people will be
forced to bear significant indirect costs due to its existence,” according to the NAHU position paper. “Existing
public programs like Medicare and Medicaid pay providers a reduced rate as a financing
mechanism. There is a great deal of evidence to show that providers then shift these costs onto the private
payers. Any expansion of a public program or buy-in plan would only increase the amount of cost
being shifted to the privately insured.”
 Warming Defense---1NC
No warming impact---their predictions are wrong and adaptation
solves
Oren Cass 17, senior fellow at the Manhattan Institute, Winter 2017, “How to Worry about
Climate Change,” National Affairs, http://www.nationalaffairs.com/publications/detail/how-to-
worry-about-climate-change
Even focusing within that range, estimates
for the expected environmental impacts of warming vary
widely. The IPCC represents the gold standard for synthesizing scientific estimates, and,
crucially, its best guesses bear little resemblance to the a pocalyptic
predictions often repeated by activists and politicians. For instance, the IPCC estimates that
At the high
sea levels have risen by half a foot over the past century and will rise by another two feet over the current century.
end of the 3-to-4-degree range, it reports the impact on ecosystems will be no worse than that of
the land-use changes to which human civilization already subjects the natural
world.
The responsibility
for translating these and other disruptions into economic costs falls to Integrated
Assessment Models (IAMs). To create its "Social Cost of Carbon," the Obama administration surveyed this economic
literature and focused specifically on three models whose forecasts themselves vary widely, even starting from a common level of
warming. For warming of 3 to 4 degrees Celsius by 2100, the middle of the three models estimates an annual cost of 1% to 3% of
GDP. The low case estimates 0 to 1%. The high case estimates 2% to 4%. While
4% is a large dollar amount, arriving
at that impact over nearly 100 years implies almost imperceptibly small changes in
economic growth.
The specifics of this high-case model are informative: The Dynamic Integrated model of Climate and the Economy (known as the
DICE model) developed by William Nordhaus at Yale University estimates 3.8 degrees Celsius of warming by 2100
costing an associated 3.9% of GDP in that year. But over time, this cost is the equivalent of slowing
economic growth by less than one-tenth of one percentage point annually . By 2100, regardless of
climate change, the world is more than six times wealthier than in 2015 under this model; global GDP is
$500 trillion. The effect of climate change is to reduce that gain from a multiple of 6.7 to a multiple of 6.5. The economy also
continues to grow, so that the climate-change-afflicted world of 2105 is already much wealthier
than a world of 2100 facing no climate change at all.
Such estimates might seem counterintuitively low, especially given the rhetoric often employed. Part of the explanation lies in the
almost incomprehensible economic progress that human civilization is capable of making over the course of a century. The annual
cost identified by Nordhaus in 2100 is $20 trillion — massive by the standards of 2015, manageable by the standards of 2100.
Further, that cost repeats every year even as the impacts are spread over many years. Thus, over the 2090 to 2110 time period,
Nordhaus envisions the world spending a stunning $350 trillion to cope with climate change. One might despair over what else such
resources might accomplish over that time period. But one must also recognize that the
economy of 2100 will likely be
able to allocate those resources toward climate change while also allocating to every other facet
of society far more resources than are available today.
Corroborating these models, the IPCC concludes that "for most economic sectors, the impacts
of drivers such as changes in population, age structure, income, technology, relative prices, lifestyle,
regulation, and governance are projected to be large relative to the impacts of climate change ." In
other words, other worrying problems have a far greater capacity to influence progress.

None of this means the dislocations from climate change would be painless or the disruptions cheap. It is merely to
observe that the impacts expected from climate change over the next hundred years look similar to
those through which both civilization and our planet have successfully muddled
over the past hundred and continue to struggle with today. Other worrying problems have their own
anticipated but less-severe analogs, too. Whether a global pandemic strikes, epidemics will inevitably occur like the 2014 Ebola
outbreak in West Africa that claimed more than 10,000 lives and cost the three countries at its center more than a tenth of their
GDP. Whether artificial intelligence makes humans superfluous, self-driving vehicles could throw millions out of work in the years
to come. Some countries will default on their debt; some business cycles will spawn deep global recessions.

These challenges are not existential threats or even ones that require analysis outside the
standard policy process — that is, they are not really worrying problems at all.
EXTREME CASES

If expected climate change represents the most likely outcome, extreme climate change
represents the worst case: Models could be underestimating the warming that emissions will cause; feedback loops
could send a 3-degree increase suddenly careening higher; or even at the expected level the climate could hit a tripwire that
collapses global ecosystems or ocean currents or ice sheets or some other prerequisite of modern
civilization.
Any of these things may be true — as is the nature of genuinely forecasted challenges, they are mostly non-falsifiable. But while
extreme climate change is a quintessentially worrying problem, it is also one that has no guarantee or even
likelihood of occurring. Certainly, the "scientific consensus" or even the "scientific mainstream" on climate
change does not extend to confidence in such scenarios .
To compare extreme climate change with other worrying problems, it is helpful to consider the dimensions that make a problem
"worrying": that it is forecasted, irreversible, and pervasive. On all three, climate change appears less worrying than most.

Consider, first, the magnitude of the forecasted impact. Many worrying problems feature the
credible prospect of killing a significant share of the human population or erasing modern
civilization. Not extreme climate change. For instance, even considering higher temperature
increases, the IPCC concludes that:
Global climate change risks are high to very high with global mean temperature increase of 4°C or more above preindustrial levels
in all reasons for concern, and include severe and widespread impactson unique and threatened systems,
substantial species extinction, large risks to global and regional food security, and the combination of high temperature
and humidity compromising normal human activities, including growing food or working outdoors in some areas for
parts of the year.

Obviously, each of those effects would entail enormous economic costs, carry severe consequences for entire
nations, and wreak havoc with the natural environment. But as a worst case, it nevertheless pales in
comparison to catastrophes that might kill a significant share of the human population or erase
the basic physical and economic infrastructure of modern civilization .
Serious efforts to quantify existential threats concur. A 2016 report by the Global Priorities Project at Oxford
offered as its example of a worst case that climate change could "render most of the tropics substantially
less habitable than at present," as compared to hundreds of millions or billions of deaths associated
with other challenges. Another Oxford study from 2008 asked conference participants to estimate the
probability of various global catastrophes leading to human extinction in the coming century, and did
not even see fit to include climate change as an option , while respondents gave molecular
nanotechnology, super-intelligent artificial intelligence, and an engineered pandemic each at least a 2% chance of erasing humanity
by 2100.

Some analysts nonetheless place climate change among humanity's genuinely existential threats on the
basis of its "fat tail," arguing that some unknowable but non-zero chance exists at the far-right end of the
probability distribution for an outcome with essentially infinite cost. But this is true of all worrying
problems — indeed, the characteristics of worrying problems might be viewed as those that generate such unknowable non-zero
probabilities. Climate change cannot be distinguished from other worrying problems on that basis .
Rather, theargument begs the question: What characteristics of climate change make its tail
relatively fatter or thinner?
The weight
accorded to a worrying problem's forecasted effects depends greatly on the number of
causal steps between the underlying phenomena and worst-case outcomes. Where
fewer steps are necessary, or where steps are relatively more likely to occur, the probability of the worst case arising should increase.
For instance, whether an engineered pandemic devastates humanity depends on development of the necessary technology (highly
likely), its use by a malicious actor (indeterminate), and its spread defying efforts at containment (indeterminate). Generally
speaking, technological threats will have the shortest chains while sociological threats will have the longest ones.

Climate change would appear to sit somewhere in between. It has a very short chain to some impact — indeed,
higher atmospheric concentrations of carbon dioxide are already having effects. But the connection from warmer
temperatures to civilizational catastrophe is highly attenuated. The initial warming must cross
thresholds that produce feedback loops. The ensuing warmth must produce environmental effects that cause unprecedented
crises across societies. Those crises must in turn overwhelm the coping capacity of the entire global
community, which must in turn produce wide-scale breakdowns in social order or trigger military conflict,
which must in turn metastasize into...what? Certainly, one can invent a scenario. But the
specifics quickly become hazy, and a worst case entirely outside of human experience
difficult to articulate.
The intent of this analysis is not to dismiss the severity of worst-case climate scenarios or to suggest that "wide-scale breakdowns in
social order" are acceptable. But all worrying problems have worst-case forecasts that look this way , all
with indeterminate probabilities of occurring, which leaves only a few options: We could become overwhelmed with despair,
emphasize whichever problems are most politically useful, or seek out qualitative and quantitative bases for analysis. Too much
discussion of climate change adopts the first or second approach. Efforts at the third approach will inevitably be imprecise and
imperfect, but the
burden of proof should lie on those declaring that climate change stands apart
from other worrying problems to explain why that is so. The suggestion here is not that the forecasted threat of
climate change does not belong alongside other worrying problems, only that the nature of its forecast cannot be what separates it as
uniquely worrying.

WORRYING IN SLOW MOTION

In the other ways climate change is a worrying problem, meanwhile, it is less worrying than most. This is
especially true with respect to irreversibility. While President Obama has lamented that climate change is a
"comparatively slow-moving emergency," the one thing worse is a fast-moving one. Most worrying problems have
worst-case scenarios that sweep the globe in a matter of months, days, or even minutes. For
climate change, the damage unfolds over decades or centuries. This has several implications.
First, while climatechange is irreversible compared to the typical policy problem, it does allow for some potential
interventions even once well underway. For instance, natural processes already exist for
extracting carbon dioxide from the atmosphere, and new technologies could be developed that accelerate
those processes or create artificial ones. Alternatively, humans could use so-called "geoengineering" to effect other
changes in the climate system that might counteract an intensifying greenhouse effect. These approaches offer no guarantee or even
likelihood of success; turning to geoengineering might be seen as a disaster in its own right. But they offer more cause for optimism
than exists with many other worrying problems.

Second, timepermits adaptation. While the prospect of losing 50% of existing agricultural capacity is
daunting, over a 50-year period only 1% of capacity needs to shift annually. By comparison, over the
past 50 years, total agricultural output has tripled. Similarly, the need for hundreds of millions of people
to migrate over a century amounts to little out of the ordinary on an annual basis. There are, for instance, more than 200 million
migrant workers within China, as well as another 200 million international migrants and at least 60 million refugees around the
world right now. The United Nations estimates 2.5 billion people will migrate to cities in just the next 35 years. Further migration, or
perhaps the gradual abandonment of some cities or even entire regions, would obviously be extraordinarily costly and disruptive in
human, economic, and environmental terms. But the reason such adaptations are rarely mentioned in the context of other worrying
problems is not that they would be unnecessary, but rather that, in those other cases, they would be either impossible or else futile.
Purveyors of creatively catastrophic climate cases also face a Catch-22: Developing ever-more
extreme scenarios typically requires ever-longer timescales. Even higher
temperatures and risks of further dominos falling are threatened — by 2300, or after "centuries."
Confident forecasts of multi-meter sea-level rises are issued, to occur over multiple millennia .
Harvard University's Martin Weitzman, the leading proponent of the case that climate change presents a uniquely "fat tail," falls into
if
precisely this trap: The worst case he offers relies on continued temperature increases over multiple centuries. But
heightening the threat requires extending the timeframe further, it becomes diluted threefold: More
time becomes available for adaptation, for economic progress and technological
innovation that render the threat irrelevant, or for the model to fail. Any impact forecasted for 200, let
alone 2,000, years into the future becomes almost inherently less cognizable than those already under study for 2100.
 Bioterror D---1NC
No impact to bioterror
Filippa Lentzos 14, PhD from London School of Economics and Social Science, Senior Research
Fellow in the Department of Social Science, Health and Medicine at King’s College London,
Catherine Jefferson, researcher in the Department of Social Science, Health, and Medicine at
King’s College London, DPhil from the University of Sussex, former senior policy advisor for
international security at the Royal Society, and Dr. Claire Marris, Senior Research Fellow in the
Department of Social Science, Health and Medicine at King's College London, “The myths (and
realities) of synthetic bioweapons,” 9/18/2014, http://thebulletin.org/myths-and-realities-
synthetic-bioweapons7626
The bioterror WMD myth. Those who have overemphasized the bioterrorism threat typically portray it as an
imminent concern, with emphasis placed on high-consequence, mass-casualty attacks,
performed with weapons of mass destruction (WMD). This is a myth with two dimensions.¶ The first involves the identities of terrorists and
what their intentions are. The assumption is that terrorists would seek to produce mass-casualty weapons
and pursue capabilities on the scale of 20th century, state-level bioweapons programs. Most leading biological disarmament
and non-proliferation experts believe that the risk of a small-scale bioterrorism attack is very real and present. But they
consider the risk of sophisticated large-scale bioterrorism attacks to be quite small. This judgment is
backed up by historical evidence. The three confirmed attempts to use biological agents against humans in terrorist attacks
in the past were small-scale, low-casualty events aimed at causing panic and disruption rather than excessive death tolls. ¶ The
second dimension involves capabilities and the level of skills and resources available to terrorists. The implicit assumption is that
producing a pathogenic organism equates to producing a weapon of mass destruction. It does not.
Considerable knowledge and resources are necessary for the processes of scaling up, storage, and
dissemination. These processes present significant technical and logistical barriers.¶ Even if a biological
weapon were disseminated successfully, the outcome of an attack would be affected by factors like the health of the people who
are exposed and the speed and manner with which public health authorities and medical professionals detect and respond to the resulting outbreak. A
prompt response with effective medical
countermeasures, such as antibodies and vaccination, can
significantly blunt the impact of an attack.
 Disease D---1NC
Infectious diseases don’t cause extinction
Owen Cotton-Barratt 17, et al, PhD in Pure Mathematics, Oxford, Lecturer in Mathematics at
Oxford, Research Associate at the Future of Humanity Institute, 2/3/2017, Existential Risk:
Diplomacy and Governance, 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
natural pandemics are very unlikely to cause human extinction. Analysis of
reasons to believe that
of the 833 recorded plant
the International Union for Conservation of Nature (IUCN) red list database has shown that
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
Markets
 Econ D---1NC
Economic crises don’t cause war
Christopher Clary 15, Ph.D. in Political Science from MIT, Postdoctoral Fellow, Watson Institute
for International Studies, Brown University, “Economic Stress and International Cooperation:
Evidence from International Rivalries,” April 22, 2015,
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2597712
Do economic downturns generate pressure for diversionary conflict? Or might downturns encourage austerity and economizing
behavior in foreign policy? This paper provides new evidence that economic stress is associated with
conciliatory policies between strategic rivals. For states that view each other as military threats, the biggest step possible
toward bilateral cooperation is to terminate the rivalry by taking political steps to manage the competition. Drawing on data
from 109 distinct rival dyads since 1950, 67 of which terminated, the evidence suggests rivalries
were approximately twice as likely to terminate during economic downturns than they were during
periods of economic normalcy. This is true controlling for all of the main alternative
explanations for peaceful relations between foes (democratic status, nuclear weapons possession, capability imbalance,
common enemies, and international systemic changes), as well as many other possible confounding variables. This
research questions existing theories claiming that economic downturns are associated with diversionary war, and instead argues that
in certain circumstances peace may result from economic troubles.
Defining and Measuring Rivalry and Rivalry Termination

I define a rivalry as the perception by national elites of two states that the other state possesses conflicting interests and presents a
military threat of sufficient severity that future military conflict is likely. Rivalry termination is the transition from a state of rivalry
to one where conflicts of interest are not viewed as being so severe as to provoke interstate conflict and/or where a mutual
recognition of the imbalance in military capabilities makes conflict-causing bargaining failures unlikely. In other words, rivalries
terminate when the elites assess that the risks of military conflict between rivals has been reduced dramatically.

This definition draws on a growing quantitative literature most closely associated with the research programs of William Thompson,
J. Joseph Hewitt, and James P. Klein, Gary Goertz, and Paul F. Diehl.1 My definition conforms to that of William Thompson. In
work with Karen Rasler, they define rivalries as situations in which “[b]oth actors view each other as a significant political-military
threat and, therefore, an enemy.”2 In other work, Thompson writing with Michael Colaresi, explains further:

The presumption is that decisionmakers explicitly identify who they think are their foreign enemies. They orient their military
preparations and foreign policies toward meeting their threats. They assure their constituents that they will not let their adversaries
take advantage. Usually, these activities are done in public. Hence, we should be able to follow the explicit cues in decisionmaker
utterances and writings, as well as in the descriptive political histories written about the foreign policies of specific countries.3

Drawing from available records and histories, Thompson and David Dreyer have generated a universe of strategic rivalries from
1494 to 2010 that serves as the basis for this project’s empirical analysis.4 This project measures rivalry termination as occurring on
the last year that Thompson and Dreyer record the existence of a rivalry.5

Why Might Economic Crisis Cause Rivalry Termination?

Economic crises lead to conciliatory behavior through five primary channels. (1) Economic crises lead to austerity
pressures, which in turn incent leaders to search for ways to cut defense expenditures. (2)
Economic crises also encourage strategic reassessment, so that leaders can argue to their peers and their
publics that defense spending can be arrested without endangering the state. This can lead to threat deflation, where
elites attempt to downplay the seriousness of the threat posed by a former rival. (3) If a state faces multiple
threats, economic crises provoke elites to consider threat prioritization, a process that is postponed
during periods of economic normalcy. (4) Economic crises increase the political and economic
benefit from international economic cooperation. Leaders seek foreign aid, enhanced trade, and
increased investment from abroad during periods of economic trouble. This search is made easier if tensions are reduced
with historic rivals. (5) Finally, during crises, elites are more prone to select leaders who are perceived as capable of resolving
economic difficulties, permitting the emergence of leaders who hold heterodox foreign policy views. Collectively, these mechanisms
make it much more likely that a leader will prefer conciliatory policies compared to during periods of economic normalcy. This
section reviews this causal logic in greater detail, while also providing historical examples that these mechanisms recur in practice.
 Costs Not K2 Econ---1NC
Health care costs aren’t key to the economy
John R. Graham 16, a public-policy analyst, is Director of the Health Technology Forum: DC;
and a Senior Fellow at the National Center for Policy Analysis. 4/20/16, “The U.S. Health
System Is Not An Economic Burden”
https://www.forbes.com/sites/theapothecary/2016/04/20/the-u-s-health-system-is-not-an-
economic-burden/#10720a622832
Health spending consumes a higher share of output in the United States than in other countries .
In 2013, it accounted for 17% of Gross Domestic Product. The next highest country was France, where health
spending accounted for 12% of GDP. Critics of U.S. healthcare claim this shows the system is too expensive
and a burden on our economy, demanding even more government intervention. This conclusion is misleading
and leads to poor policy recommendations, according to new research published by the National Center for Policy
Analysis (U.S. Health Spending is Not A Burden on the Economy, NCPA Policy Report No. 383, April 2016).

Discussing health spending in dollars, rather than proportion of GDP, the report notes Americans spent $9,086 per capita on
healthcare in 2013, versus only $6,325 in Switzerland, the runner-up. (These dollar figures are adjusted for purchasing power parity,
which adjusts the exchange rates of currencies for differences in cost of living). This big difference certainly invites us to question
whether we are getting our money’s worth. However,
it is not clear that this spending is a burden on
Americans, given our very high national income .

After subtracting health spending from U.S. GDP, we still had $44,049 per capita to spend on all
other goods and services we value. Only two countries, Norway and Switzerland, beat the U nited
S tates on this measure. But compared to larger developed countries , Americans have
higher income per capita after subtracting healthcare spending . For example, in the United
Kingdom, GDP per capita after health spending was only $34,863 in 2013. So, even though
Americans spent significantly more on healthcare than the British, the average American
enjoyed $9,185 more GDP after health spending than his British peer; and just under $6,000
more than his Canadian neighbor.
Britain socialized its health system shortly after World War II, completing the work by 1948. Canada’s healthcare was more
gradually socialized by provincial and federal governments during the period 1947 through 1966. Many assert these so-called single-
payer systems relieved the burden of private payment from citizens and made the economy more productive.

On the contrary: Since

1960, the U.S. economy has outperformed all comparable developed countries
except Norway and Switzerland with respect to economic growth, after subtracting health
spending. From 1960 through 2013, the share of U.S. GDP allocated to healthcare more than
tripled. However, this had no impact on the ability of the U.S. economy to deliver
high GDP per capita, outside healthcare . Adjusted for purchasing power parity, U.S. health spending
increased $8,937, while GDP per capita increased $50,269, from 1950 through 2013. Thus, GDP per capita available for other goods
and services, after spending on health care, increased $41,332, or $780 per year.
 Costs UQ---1NC
Health care cost growth is decreasing
John Holahan 17, Institute fellow in the Health Policy Center at the Urban Institute, former
director of the Health Policy Center, “The Evidence on Recent Health Care Spending Growth
and the Impact of the Affordable Care Act,” May 2017,
https://www.urban.org/sites/default/files/publication/90471/2001288-
the_evidence_on_recent_health_care_spending_growth_and_the_impact_of_the_affordable
_care_act.pdf

National health expenditures grew at historically low rates in recent years (3.6 percent per year on
average in between 2009 and 2013),7 and projections for future growth rates are significantly below
those experienced over recent decades. Average annual growth rates between 1970 and 2010 were equal to growth in
GDP plus 2.5 percent.13 Current estimates from the Centers for Medicare & Medicaid Services (CMS) indicate that the average
annual growth in NHE between 2010 and 2020 will be GDP growth plus 0.8 percent ; for 2020 to
2025, CMS projects the increase in NHE to be GDP growth plus 1.2 percent. The slow growth in recent years was at least partly
related to the recession and slow economic recovery,14,15 but other
factors, including changes associated with the ACA,
seem to have contributed as well; evidence indicates and analysts predict that these and other factors are likely to cause
these slower growth rates to persist into the future.

CMS routinely revises its spending forecasts as new data become available. The most recent forecast, released in February 2017,
includes actual spending estimates for 2010 to 2015, and projections for 2016 to 2025.7 Table 1 compares the current (2017)
estimates of actual spending growth to the forecast for 2010 to 2015 spending that was made shortly after the ACA passed in 2010.10
The most recent estimates suggest NHE grew 4.3 percent annually from 2010 to 2015 compared with the original forecast of 6.5
percent. Current estimates of growth in each component of NHE spending for the 2010 to 2015 period are lower than the original
forecast, from 5.8 percent to 4.5 percent for Medicare, from 9.9 percent to 6.5 percent for Medicaid, and from 6.6 percent to 4.4
percent for private insurance. “Other” health spending, which includes spending on the Children’s Health Insurance Program, the
US Department of Defense and Veterans Affairs health programs, public health activity, and investments, including new
construction and capital equipment, was originally projected to increase 5.8 percent; the spending for that category actually grew 3.1
percent.

Actual NHE growth from 2010 to 2015 was lower than projected in 2010 for several reasons. Those reasons include the 2007
to 2009 economic recession and slow recovery, unexpectedly low inflation, increased employer offerings of high-deductible
cost-containment efforts within
insurance plans (higher cost-sharing requirements lead to lower use of care),
state Medicaid programs, and Medicare policies unrelated to the ACA, including cuts as a result of
sequestration. But the ACA , too, probably contributed to low NHE growth in several ways.10

Many of the cost-containment provisions of the ACA were reflected in the 2010 forecast, including the Medicare payment reductions
to hospitals and other providers; the reduction in Medicare Advantage payments; and the managed competition structure in
marketplaces that limited subsidies to the second-lowest-cost silver plan, in turn forcing insurers to price aggressively. Thus, any
contribution of the ACA to reductions in projected spending not already in the baseline would have come from larger-than-
anticipated effects of these provisions or from other factors. Many
ACA-related factors that were not included in
the original projections may have helped slow spending growth. First, starting in 2011, adjustments to
ACA Medicare payments seem to have played a role in reducing the number of Medicare
hospital days , outpatient visits , skilled nursing facility days , and advanced imaging
procedures between 2010 and 2014.16 Second, lower Medicare payment rates may have had
spillover effects on other payers; commercial insurers often use Medicare as a benchmark for their negotiations with
hospitals and physicians.17–19 Finally, Medicare policies such as financial penalties for hospital readmissions
may have changed provider practice patterns for patients of other payers as well.
The lower-than-expected spending from 2010 to 2015 has also contributed to lower projected spending through 2019. We compare
the estimates for the 2014 to 2019 period (the current forecast), which reflect actual data for 2014 and 2016 and projections for 2016
to 2019, to the projections made for the same period in 2010. We find that the most recent 2017 CMS forecast estimated that
national health expenditures for 2014 to 2019 would total $20.8 trillion;7 this is $2.9 trillion, or 12 percent, below the CMS forecast
of $23.7 trillion for the same period made in late 2010, shortly after the ACA was passed (Figure 1).10

The 2017 forecast also estimated lower spending for Medicare, Medicaid and private
insurance , compared with the 2010 forecast of spending after enactment of the ACA (data not shown). Medicare
expenditures for 2014 to 2019 were projected to be $4.3 trillion in the 2017 forecast, down from $4.7 trillion in the original 2010
ACA baseline forecast. In the 2017 projections, Medicaid spending for 2014 to 2019 was projected to be $3.5 trillion, compared with
$4.6 trillion in the ACA baseline forecast. Some, but not all, of this decline stemmed from the Supreme Court decision that made
Medicaid expansion a state option.20 Private health insurance expenditures for the 2014 to 2019 period were projected to be $7.7
trillion in the ACA baseline forecast but fell to $7.0 trillion in the updated 2017 forecast.
2NC
 Solves Pre-existing Conditions/Health Status---2NC
The counterplan leads to health status insurance---Solves pre-existing
conditions, job lock, and coverage
John H. Cochrane 9, Myron S. Scholes Professor of Finance at the University of Chicago Booth
School of Business, 2/18/09, “Health-Status Insurance How Markets Can Provide Health
Security” https://object.cato.org/sites/cato.org/files/pubs/pdf/pa-633.pdf
The Problem of Long-Term Insurance

None of us has health insurance, really. Most Americans have coverage through their employer ,
or the employer of a parent or spouse. But suppose you get cancer, heart disease, HIV, have a stroke,
discover a genetic defect, or develop any other long-term expensive health problem—and then
lose your job, divorce, outgrow your parents’ plan, or your employer or insurer goes out of
business. You lose your health coverage. You now have a preexisting condition, and
insurance will be enormously expensive—if it’s available at all. This happens to real people. A significant and
expensive health problem is a common root cause of catastrophic economic descents in the United States. Many people stick with
bad jobs or bad marriages just to keep their health insurance.

The lack of secure, long-term, portable health insurance is the greatest single problem with our
current health care system. Solving this problem is a central goal of every health care reform proposal from all parts of the
political spectrum. There are plenty of other problems with our health sector: the uninsured, hospitals’ hotel-minibar pricing
policies, poor information, the drudgery of useless paperwork, cost recovery of new medicines, optimal copayment levels, and so on.
But all of these are fairly clear problems, each limited in itsreach, with fairly clear remedies. The lack of long-term insurance, by
contrast, seems a harder nut to crack. And unlike, say, the plight of the uninsured, it is a problem that faces each of us directly.

Free and competitive markets are the best way to spur innovation, provide better service, and
reduce costs. So far, however, many people have thought that competition undermines long-term insurance, leading to the
extensively regulated market we now face and to proposals for further regulation. Health-status insurance lets us
break out of this dilemma. Health-status insurance can give us both completely portable,
lifetime health insurance and great individual freedom of choice in a deregulated, competitive—
and hence—efficient and innovative market.
Unsurprisingly, health-status insurance requires a thoughtful deregulation of insurance markets,
starting with an end to the strong tax and regulatory preference for employer provided group
coverage. It does not need a new layer of regulation. The small individual insurance market is already
starting to feel its way toward health-status insurance. The deregulatory path will allow this
effort to blossom fully.
Health-Status Insurance

Market-based lifetime health insurance has two components: medical insurance and health-
status insurance. 1 Medical insurance covers your medical expenses in the current year, minus
deductibles and copayments. Health-status insurance covers the risk that your medical
insurance premiums will rise. If you get a long-term condition that moves you into a more
expensive medical insurance premium category, health-status insurance pays you a lump sum
large enough to cover your higher medical insurance premiums, with no change in out-of-
pocket expenses.
Why can’t medical insurers just charge everyone the same premium? In a competitive market, medical insurers must charge sick
people higher premiums, and charge healthy people lower premiums. If an insurer charged everyone the same price, then a
competitor could woo away healthy low-cost customers, and the original insurer would go out of business. Furthermore, the main
reason insurance companies refuse coverage, deny coverage for preexisting conditions, or more subtly avoid or mistreat people with
long-term expensive conditions, isthatthey cannot charge those people enough to covertheir costs. If medical insurers can
charge enough, they will compete for the business of every customer, even the sickest. Freely risk-
rated, competitive medical insurance gives everyone access, albeit at a cost. It leaves people vulnerable to the financialrisk of large
premium increases, but health-status insurance would fill that gap.

The combination of health-status insurance and competitive, freely priced medical insurance
solves the central problem of our current health insurance market: the lack of real, long-term,
portable health security. With health-status insurance, you can always get medical insurance, no
matter if you get sick, change or lose jobs, move, divorce, take some time out of the labor force, or
even let your medical insurance lapse. The lump-sum payment from the health-status insurer means you can always
pay your medical insurance premiums.

Health-status insurance would also give each of us much greater freedom and choice. No
matter how sick you become,
you would always be free to change medical insurers. You could always afford the higher
premiums a new medical insurer will demand, just as you could afford the higher premiums
your current insurer will require. You would not depend on the good treatment of one insurer,
the vagaries of one group, the link to one employer, or the bureaucratic decisions of one
government-provided plan.
Best of all, when every consumer is free to switch insurers at any time, medical
insurance companies will compete
for everyone’s business. They will compete for the business of expensive, high-risk customers,
rather than try to get rid of them or “contain their costs.” They can also compete for the business of people who
are currently healthy, as such competition will not undermine the implicit cross-subsidy to people with preexisting conditions.
Constant competition for every consumer will have the same dramatic effects on cost, quality, and innovation in health care as it
does in every other industry.

In sum, health-status insurance can simultaneously give us complete and portable long term
insurance, great individual choice, and cost-containment beyond the dreams of any health
policy planner. And, as I show below, it doesn’t cost consumers anything. The combined health-status and medical insurance
premiums are the same as those of a lifetime individual insurance contract, and the same in present value terms as those of a
(hypothetical) successful group or pooling program, even before we factor in cost savings from greater competition.

And, it solves children and truly pre-existing conditions---starting

with government subsidization of health-status accounts gets the
process started, and leads to a system of total coverage
John H. Cochrane 9, Myron S. Scholes Professor of Finance at the University of Chicago Booth
School of Business, 2/18/09, “Health-Status Insurance How Markets Can Provide Health
Security” https://object.cato.org/sites/cato.org/files/pubs/pdf/pa-633.pdf
and a Research Associate at the National Bureau of Economic Research.
What about People Who Are Already Sick?

Private insurance cannot cover events that have already happened. You can’t tell an
insurance company, “My house just burned down. How about some insurance?”
Many people feel that government should insure events that have already happened, especially
when no insurance was available and the unfortunate are in some sense blameless . Health-status
insurance accounts offer a good way to help people who are already sick. The government
could simply deposit money in an individual’s health-status insurance account and
then get out of the way. Private charities could help people in the same way. This is much more
straightforward, flexible, and less distortionary of markets than directly running a government-sponsored
health insurance plan, or forcing private insurers to take such patients and treat them well.
The problem of people who have preexisting conditions is most critical at start up, when people will not yet have had a chance to buy
health status insurance. Once
health-status insurance is widely available, people will be able to insure
against more events than one might think. Parents could buy family insurance that provides
health-status insurance accounts for their children. Then, children who develop rare long-
term diseases would be covered for life without government intervention. Health-status insurance
could even apply to unborn children, and thus insure against genetic defects from birth.
Having the government set up such accounts for people with preexisting conditions might also
be useful in getting the whole process going. This step would establish the legal and regulatory framework for
health-status insurance accounts, and it could be done at the same time government deregulates premiums: regulators and
legislators would be more willing to allow free risk-rating if they knew that the most vulnerable populations could afford the extra
payments.
 AT Insurers Screw Over Sick People
Health status insurance forces insurers to treat Sick people well
John H. Cochrane 9, Myron S. Scholes Professor of Finance at the University of Chicago Booth
School of Business, 2/18/09, “Health-Status Insurance How Markets Can Provide Health
Security” https://object.cato.org/sites/cato.org/files/pubs/pdf/pa-633.pdf
Choice and Security

Why not just mandate that premiums cannot rise when you get sick? As it happens, federal law already
requires that individually purchased medical insurance be “guaranteed renewable,” meaning that the insurance company cannot
drop you or increase your premiums if you get sick.

There are two problems with this arrangement. First, as with all pooling arrangements, simple
long-term insurance policies are undermined by competition. Second, if you get sick you depend
on the good graces of one company, for the rest of your life, as nobody else will take you. It is
possible to fix the first problem, and markets are heading in that direction already. The second problem remains, and
health-status insurance is the natural remedy.
To see the first problem, return to the above illustration, in which there is a 1 percent probability that a person’s expected medical
expenses would transition from $2,000 per year to $10,000 per year in the first year of an insurance contract. The average medical
costs for all individuals would be (0.99 x $2,000) + (0.01 x $10,000) = $2,080.

It seems the insurer could break even by offering guaranteed-renewable policies for $2,080 per year. However, if there is any
competition, this arrangement will fall apart after the first year. Another
insurer charging just $2,000 per year
could woo away all the healthy people. The same competitive pressures unravel forced-pooling
arrangements, as discussed below.
Fortunately, markets can solve this problem by front-loading the premiums. 5 If each person pays $3,483.70 in the first year and
$2,000 in subsequent years, the insurer will still break even, but healthy people will no longer have an incentive to leave. Even if
another insurer lures them away, the additional first-year premiums would cover the long-term costs of the people who got sick.
Bradley Herring and Mark Pauly call this an “incentive-compatible” guaranteed renewable contract. 6

Notice that the premiums and calculations of an incentive-compatible guaranteed-renewable insurance policy are exactly equal to
the combined premiums of a medical insurance policy plus a health-status insurance policy, and the present value of both is the
same as those of a $2,080-per-year pooling arrangement, if the latter could be made to work.

More importantly, a health-status plus medical insurance policy is exactly equivalent to an incentive-compatible guaranteed-
renewable policy, in which the insurance company periodically “marks to market” its long-term obligations to the customer, or the
two parties occasionally settle up the long-term debt implied by the promise to treat the expensive customer. At the end of the first
year, the insurance company selling guaranteed-renewable coverage should look at each patient who developed a long-term illness
and say, “This person is going to cost us(say) $8,000 per year.

We should write down the company’s value by $148,370”—the present value of $8,000 per year in my example. In the health-status
insurance model, the insurer would pay out $148,370. The company would then have no more long-term obligations and the
consumer would have no long-term contract to enforce. The implications of periodically settling up a long-term contract are
profound, and they solve the second problem of long-term individual contracts. Sick people must stay with their original insurer
forever in a guaranteed-renewable contract, whereas a health-status
insurance payment frees them to choose
another insurer. People value choice. As Thomas Buchmueller and colleagues write:
People do not want to be locked into the same health insurance plan year after year. When new medical services are developed,
people want access to those services. . . . If people move, they want to be covered by new providers, not the providers in the town
they moved from. Under guaranteed-renewable policies, only those who remain healthy can hope to switch coverage. 7

If people are bound to one insurance carrier, furthermore, the original insurer doesn’t
have any incentive to treat sick people well. Yes, reputation and court enforcement of contracts can help to
prevent insurers from treating sick people badly. But the freedom to leave is a much more effective force to
keep insurers and providers on their toes. Competition for people with long-term diseases will
also induce the whole medical industry to improve treatment of those diseases.
Finally, insurance companies don’t last forever. They can go bankrupt, change owners, change
policies, and so forth. Periodically retrieving the present value of long-term promises adds to the
safety of any contract.
We do not have to have a policy debate between guaranteed-renewable and health status insurance, however. Market participants
can decide how often it is optimal to settle up, as long as both options are permitted by law and regulation. Guaranteed-renewable
individual insurance is also a great start, because it provides a natural stepping stone to health-status insurance without requiring
major policy shifts.
 AT Adverse Selection
No adverse selection---medical history and health exams means
insurers get accurate health info
John H. Cochrane 9, Myron S. Scholes Professor of Finance at the University of Chicago Booth
School of Business, 2/18/09, “Health-Status Insurance How Markets Can Provide Health
Security” https://object.cato.org/sites/cato.org/files/pubs/pdf/pa-633.pdf
What about Adverse Selection?

People who know they are sick and can hide it tend to buy more insurance, which theoretically
can cause insurance markets to unravel. Realistically, however, “adverse selection” is not a
serious problem for long-term health insurance markets. True adverse selection refers to things patients know
that the insurer cannot know—what economists call “asymmetric information.” But does a patient who knows his or
her aches and pains really know more than an insurer can learn by looking at his or her entire
medical history and a careful health exam? (Hiding one’s history is fraud, and can
invalidate a contract.)
If we observe adverse
selection in today’s marketplace, it is because government artificially
forbids insurers from using information they do posses to charge more for people
whom everyone knows are going to be more expensive . This fact does not represent a fundamental
information problem that would stop a less-regulated market from working.

Adverse selection is exactly the same issue for health-status insurance as it is for longterm insurance with a single company. The
portability engineered by lump-sum payments doesn’t make adverse selection any better or worse. So at a minimum, this isn’t a
special issue for health-status insurance.
Econ DA
 Link Level---2NC
Public option crashes the economy---tax hikes to pay for coverage
inflate the deficit, deter employment, and collapse business and
personal investment---that’s Tanner
Public option functionally results in a single-payer system---crowds
out private insurance
Stuart M. Butler 9, Ph.D., is Vice President for Domestic and Economic Policy Studies at The
Heritage Foundation. 7/28/9, “The Case Against: The Public Plan Will Unfairly Crowd Out
Private Coverage” http://www.heritage.org/health-care-reform/commentary/the-case-against-
the-public-plan-will-unfairly-crowd-out-private
I've spent the last 30 years trying to achieve affordable health coverage for all Americans, so it's frustrating to see the obsession with
a "public plan" making it impossible for reasonable people from both parties to come together. " The fixation on a public
plan is bizarre and counterproductive," The Washington Post put it recently in an editorial. "It would be a huge
mistake for the left to torpedo reform over this question."

Why does such a seemingly benign idea pose such a dire threat? Because
supporters are disingenuous about their
real goals and about how it would really work. The arguments for a public option as the only way
to achieve certain objectives just don't stack up.
One argument is that a government-sponsored plan is needed so that Americans with modest income and chronic medical problems
-- the kind of people who are literally uninsurable -- can be assured of getting coverage.

But this overlooks everything else that has already been agreed. There's bipartisan support for subsidies and health exchanges to
assure portable, affordable coverage. Even the health insurance industry would accept revamped regulation to limit premium
variation so that sicker people can get coverage. And we've made great progress in recent years with reinsurance and risk adjustment
mechanisms to handle high-risk people.

A public plan does nothing to advance on this. It is anathema to many of the very people who are in agreement and just throws a
monkey wrench into the discussion.

A second claim is that a public plan would be a lean, mean competing machine, modeled on
Medicare. It would use its size and clout to get the best deal for working Americans and force private plans cut costs or go out of
business.

But advocates of this vision don't hide what they expect -- and even desire -- to happen. Gradually
"Medicare for All"
would crowd out most private coverage, paving the way for a cradle-to-grave single payer
system.
Now, I lived under one in Britain for 30 years and I'm glad I don't now. I don't think Americans want that system. Still, maybe I'm
wrong and they would support a single payer system after an honest national debate. But the "public option" proposal is
just a dishonest sneak end-run around that needed debate.
Far from being merely an option, a Medicare-style public
plan would unleash a dynamic that is not what
Americans thought they were voting for last November. They were assured that if they are happy with the coverage
they had then nothing would change with a public option.

But there would actually be big changes for many already insured people. Faced
with a low-cost public option, many
employers would simply close down their existing plan and push their employees into the public
plan. Remember that Wal-Mart encouraged eligible employees to sign up for Medicaid, until
states and unions thwarted them. All serious analysts agree that many Americans would find
themselves dumped into the public plan.
The respected Lewin Group estimates that under the latest House bill, as many as 103 million Americans could end up in the public
plan, with 88 million of these -- almost half of all those previously with employer-sponsored insurance -- dropped by their
employers.

So the public plan both covers up the intent of many of its proponents and has disruptive side-effects that conflict directly with the
pledge Mr. Obama has been giving.

As a response to this concern, another version calls for a more benign, soft-edged public plan, with the limited aim of making
Americans simply more comfortable with a new system including private plans. The public plan would then be "just another choice"
and choice is good, the argument goes. Such a plan would pay providers roughly the same rates as private plans and would live
under the same rules as any other plan on a "level playing field." No special advantages. No open door to the Treasury. Really just
like a private plan with a government seal of approval. What's not to like?!

A lot, starting with the question of why even have this version of a public plan if it is really no different from any other. Is it worth
possibly derailing health care reform for this?

Yet the claim that Americans somehow won't be comfortable with a set of competing plans in an exchange unless one of them is run
by the government just doesn't carry water. For instance, while a form of public plan exists for state employees in certain states, if
you take a cursory glance at state websites you will rarely see these plans ever even described as publicly administered. It turns out
not to be a selling point.

It's also the case that the 10 million federal employees, members of Congress and dependents in the federal government's system
(the FEHBP) are not clamoring for a public plan. There is no public plan in the FEHBP.

It's simply
But the reason to avoid this version shouldn't be hard for anyone who has spent time in Washington to grasp.
impossible to believe the claims by Sen. Charles Schumer (D-N.Y.) and others that Congress really will do
nothing to disrupt the level playing field by favoring the public plan. With Congress as both
umpire and a team manager, one thing is clear: it will favor its own team. The result is the
public plan will unfairly crowd out private coverage.
This is why there's a tsunami of cynicism about a public plan among those of us who know how Washington works and are trying to
build the broadly-based agreement needed for serious reform to be achieved and sustained. At best the public plan is a distraction
from this effort. At worst, and more likely, it will kill the chances of successful reform. It's time for President Obama to pull the plug
on the public "option."

It decimates the economy---tax hikes deter investment, job creation,

and entrepreneurship
Sally C. Pipes 16, president, CEO, and Thomas W. Smith fellow in health care policy at the Pacific
Research Institute. 1/21/16, “The Ugly Reality of Single-Payer”
https://www.usnews.com/debate-club/is-single-payer-health-care-a-good-idea/the-ugly-
reality-of-single-payer
Late Sunday night, just hours before the fourth Democratic presidential debate, Vermont Sen. Bernie Sanders unveiled what's
probably the purest expression to date of his unreconstructed 1970s radicalism: a plan for "universal" single-payer health
care in the United States.
Proudly titled "Medicare-for-All," the Sanders scheme would
eliminate the private insurance industry and
establish a single, federally run insurance pool open to all.
Sanders promises a healthcare utopia – a future of "no more co-pays, no more deductibles and no more fighting with insurance
companies." During Sunday's debate, the candidate claimed that his health care plan would "save the average middle-class family
thousands of dollars a year."

This is complete nonsense. Every other single-payer system around the world delivers subpar
care at astronomical cost. Worse still, the multitrillion-dollar tax hikes – that's "trillion," with a "t" –
that Sanders has proposed to finance his single-payer monstrosity would decimate the American
economy.
Voters in need of a definitive reason to dismiss Vermont's "democratic socialist" as a legitimate candidate now have one.
Sanders's "Medicare-for-All" proposal would require $14 trillion in new public spending over the next decade and would expand the
size of the federal government by over 50 percent. He plans to cover those costs by ratcheting up taxes on virtually everyone. He
wants to hike income tax rates by 2.2 percentage points and levy a new 6.2 percent payroll tax on employers. He'd also dramatically
crank up income tax rates for families making over $250,000 year. And he'd set the estate tax at 65 percent.

These new taxes would slow our economy to a halt . They'd rob businesses of capital to
invest in expansion and job creation. The returns on entrepreneurship would dwindle.
Corporations would direct investments to friendlier environs abroad.

Yes private crowd-out---tax, and regulatory advantages

John S. Hoff 9, Former Deputy Assistant Secretary for Planning and Evaluation in the U.S.
Department of Health and Human Services. Bradley fellow in Education Policy at the Heritage
Foundation. 8/26/09, “The Public Health Insurance Option: Unfair Competition on a Tilting
Field” http://www.heritage.org/health-care-reform/report/the-public-health-insurance-option-
unfair-competition-tilting-field
Depending on their tax status, private insurers must pay federal and state taxes, including
premium taxes, property taxes, and income taxes. The government insurance plan, which would be
run by the U.S. Department of Health and Human Services (HHS), would not pay these taxes, and Section 221 does
not change this. Nor would the government plan be subject to the federal and state antitrust laws
that regulate the operations of private insurers.
Moreover, the bill is unclear on whether the government plan would be required to meet state licensing standards and obtain state
licenses. Section 204 contains a general requirement that a plan offering insurance through the exchange must be licensed under
state law for each state in which it offers coverage,[6] yet state laws do not apply to the federal government unless
federal law provides that they do. The general language in Section 204 and Section 221 may not be sufficiently explicit to require the
government plan to obtain state insurance licenses. If
not, the government plan would avoid state solvency
and other requirements that private plans must meet.

The gov plan avoids tort litigation---crowds out private insurance

John S. Hoff 9, Former Deputy Assistant Secretary for Planning and Evaluation in the U.S.
Department of Health and Human Services. Bradley fellow in Education Policy at the Heritage
Foundation. 8/26/09, “The Public Health Insurance Option: Unfair Competition on a Tilting
Field” http://www.heritage.org/health-care-reform/report/the-public-health-insurance-option-
unfair-competition-tilting-field
The government plan would be shielded from the high costs of tort litigation that private
plans face. Unless exempted by the Employee Retirement Income Security Act as an employee benefits plan, a private
insurer can be sued for a variety of torts, including actions for consequential and non-economic
damages for death and injury resulting from a wrongful denial of coverage . Yet the government
plan, as an arm of the federal government, would probably be immune from tort liability. The
federal government can be sued under the Federal Tort Claims Act (FTCA), but not for
discretionary actions of its agents, and a coverage decision would probably qualify as such a
discretionary act.
Even if suit could be brought against the government plan under the FTCA, it could not be heard in a state court or before a jury, and
the government plan would not be liable for punitive damages. Furthermore, the FTCA imposes strict caps on
attorneys' fees, which significantly reduces economic incentives to stir up suits against the government, which is certainly not the
case in litigation against private parties.[8]
 AT: Death Spiral
No insurance industry bubble---price linked subsidies and premium
caps mean people won’t default on their insurance plans and the
exchanges won’t go into a death spiral
Benedic Ippolito 17, and Stan Veuger are economists at the American Enterprise Institute for
Public Policy Research. 3/21/17, “The little death spiral that couldn’t”
http://www.aei.org/publication/the-little-death-spiral-that-couldnt/
In response, an old talking point has reemerged. Sen. Lindsay Graham, among others, has suggested
letting the ACA
insurance exchanges die from their own inflicted “death spiral,” and Trump has hinted at a similar way out
of the GOP’s repeal-and-replace deathtrap. The idea is that an ACA collapse would teach Americans the fatal flaws of Obamacare,
Democrats would be blamed for their socialist schemes, and Republicans will, at long last, get the chance to implement patient-
centered health care policy, whatever that might mean in practice. Until then, perhaps the best medicine is none at all!

If only that was actually possible.

For better or for worse, it is nearly impossible for the ACA’s insurance exchanges to implode to
the extent that its detractors have long predicted. To understand why, it is important to understand
how the subsidies and regulations in the ACA work. The ACA employs “price-linked subsidies.”
That is, the premium subsidy consumers receive is based on the actual prices for insurance on the
exchanges. In addition, the ACA’s regulatory framework caps the out-of-pocket expenses faced
by consumers.
This works as follows. For those who purchase insurance on the exchange and have incomes
below 400 percent of the poverty level (nearly $100,000 for a family of four), the ACA limits
how much of your income you can spend on premiums . This amount ranges from 2
percent to 9.5 percent of income depending on the level of said income , under the assumption that you are
purchasing the second-cheapest silver plan. Once you contribute this portion of your income towards premiums, the federal
government picks up the rest of the tab. That means that even if premiums rise, once you have hit the
contribution cap, you do not have to contribute more. Critically, a full 83 percent of exchange
enrollees receive these subsidies. All of those enrollees are effectively shielded from future
premium increases.
A true death spiral – one that leaves a market bereft of sellers and buyers – relies on increasing prices driving
more and more consumers from a market. But what if consumers don’t actually pay those higher
prices?
Consider what happened last year when average
premiums for the benchmark plan increased by 22
percent. Despite the headline-grabbing increase, the Obama administration correctly predicted
that most consumers wouldn’t be affected. Unsurprisingly, this year’s enrollment numbers
held relatively steady, even with efforts by the current administration to curb enrollment (sign-ups in the final two
weeks of this year’s open enrollment were over 300,000 lower than the last week of 2016 alone).

One can reasonably argue against this type of subsidization – indeed some would suggest the federal government shouldn’t commit
to absorbing price increases indeterminately. Moreover, even the individuals on the receiving end of these government transfers
might wish they took a form other than indefinite subsidies for comprehensive health insurance. This notwithstanding, the ACA’s
current subsidy structure prevents the market from unraveling very far.
The only other avenue for “spiraling” in the insurance marketplaces is not through prices, but
rather insurance plan designs. If insurers move to control costs through increasingly high
deductibles and patient cost sharing, even some subsidized individuals could find the resulting
plans not worth buying. Yet it is difficult to imagine this mechanism truly unravelling the
market. All exchange plans are subject to out-of-pocket expenditure limits, and those limits are
quite strict for low-income consumers. Those individuals with incomes between 100 percent and 200 percent of the
poverty line, for example, are on the hook for at most $2,350 in out-of-pocket spending (that is, deductibles and copayments
combined) in a given year.

Even without a true death spiral, the ACA would continue to experience serious problems. Insurers that offer plans with more
expensive provider networks will likely continue to exit the exchanges, and some low-population markets will be left with very few or
even zero options. For the subset of non-subsidized individuals on the exchanges, price increases will be felt acutely and their
presence in the market could diminish further. But
will this reality really sell as a “death spiral?” It is hard to
imagine so, as millions of people will continue to use the exchanges.
Inaction will neither solve real problems facing the insurance market, nor trigger a true failure from which Republicans can arise as
saviors. Republicans will have betrayed their base by not repealing the ACA after almost a decade of promising to do so, while not
addressing any of the law’s flaws and weaknesses.
1NR
 Public Health—Instability—2NC
Public health inequality causes East Asian instability
James R Campbell 12, Professor at the College of Security Studies, Asia-Pacific Center for Security
Studies, 2012, Human Health Threats and Implications for Regional Security in Southeast
Asia*, in Human Security: Securing East Asia's Future,
https://link.springer.com/content/pdf/10.1007%2F978-94-007-1799-2_9.pdf
According to the World Health Organization (WHO), health is not only the absence of infi rmity and disease but also a state of
physical, mental and social well-being (WHO 1946 : 100). As
disease incidence (the number of new cases of a
particular disease within a population over time) increases, the burden on individuals, local
health care systems and other government agencies increases. New or re-emerging infectious
diseases, particularly diseases contracted from exposure to infected animals (zoonotic disease)
such as SARS, Nipah virus and avian infl uenza spread quickly within a region, creating new,
unpredictable crises for national public health systems. For biological and epidemiological reasons not fully
understood, most of the new influenza viruses that spread globally each year originate in the
Southeast Asian region. Yet treatments may not be equitably shared between countries, and international relations can
quickly deteriorate. When Indonesia sought guarantees from the WHO that any vaccine against H5N1 infl uenza that was based on
Indonesian strains of the virus would subsequently be made available to Indonesia at an affordable price, the WHO was unable or
unwilling to convince the large pharmaceutical companies to provide such a guarantee (Current Concerns 2009 ) . As a result
Indonesia withheld critical virus strains from vaccine research and development, putting itself and the region at risk, for which it
was rebuked by much of the international health community. ¶ In 2005 the WHO updated and re-issued its International Health
Regulations (IHR), which specifi es mandatory infectious disease outbreak reporting requirements for the 194 state parties to the
agreement. However the fi nancial and technological burdens of increased disease surveillance inhibited compliance with the
regulations among many of the low and middle income nations in the region. Infuture outbreaks, under authority of
the IHR, the WHO may enter a country with regionally-placed teams of experts and supplement
that nation’s resources in order to protect global public health (WHO 2005 ) . While the benefi ts of such a
policy for regional and global public health are obvious, potential disputes involving state sovereignty create
emerging threats to regional security. Diseases with pandemic potential are especially
problematic to health security, with the additional potential to cause political unrest and civil
disorder, deplete military forces, destabilize nations and contribute to state failure. These
diseases also affect regional health security indirectly, through strategic impacts on important Asian
neighbors like China. The most populous nation on Earth, China earned the enmity of the entire international health
community for its dilatory response to the global outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003 (Maclean 2008 :
475). Because of the tremendous disparity between countries in planning and response capabilities for dealing with pandemics, in
any global pandemic such as the H5N1 avian infl uenza outbreak developing
countries in Southeast Asia will likely
experience proportionately more morbidity and mortality than developed nations, due to
limited access to any vaccines and anti-viral medications like oseltamivir (Tamifl u). Ill-will generated
by such health inequity and perceived injustice could potentially damage international relations
and impact regional stability. ¶ In 2004 the Global Fund offered $100 million in grants to fi ght tuberculosis,
malaria and HIV/AIDS in Myanmar. However in 2005, because of serious concerns about governance in that country and the
unwillingness of the ruling military junta to respect the project’s safeguards and performance-based grant implementation the funds
were rescinded (Global Fund 2005 ) . As a result these highly infectious diseases rampant in Myanmar have returned as imminent
health security threats to neighboring countries. Border regions within Myanmar populated by ethnic minorities and marked by
ongoing civil confl ict suffer the highest national incidences of malaria. The ramifi cations for transnational health security are
obvious, because regions within India, Bangladesh, Laos, Thailand and China that border Myanmar all have signifi cantly higher
incidences of malaria, tuberculosis and HIV/AIDS than other regions of those countries (Beyrer and Lee 2008 : 2). Myanmar has
one of the largest AIDS epidemics in Asia, and this can be as destabilizing as war. The age demographic affected most directly by
AIDS includes the most productive segments of society, such as military and civil servants, business owners, teachers and parents.
Higher mortality in these sub-populations results in an increased proportion of the young and
the old, creating a less stable and more fragile social situation. By framing infectious diseases as a matter of
national security with regional implications, governments and their people will be better prepared to handle sudden outbreaks
that endanger human lives and threaten the existence and survival of nation-states
(Caballero-Anthony 2005 ) . ¶ Another factor that destabilizes regional human security is the
large number of the world’s
poorest people residing in Southeast Asia who lack access to essential medicines to treat these
diseases, which argues strongly for health programs that emphasize prevention of disease. Besides the expense factor, this lack of
access is also due to poor infrastructure, lack of technical assistance and uncertain quality of pharmaceuticals (International
Dispensary Association 2009 ) . The production, distribution and use of counterfeit medicines represent a thriving transnational
crime in Southeast Asia. These fake drugs, either less than full strength or containing no drug at all, also are an increasing public
health problem for the region, often with tragic results (Fernandez et al. 2008 : 585, Newton et al. 2008 : e32). Under-strength
drugs are particularly insidious because they contain enough of the active compound to foil screening tests yet not enough to treat
the disease, while at the same time the reduced potency accelerates the evolution of drug resistant strains of dangerous human
pathogens.

Instability escalates – domestic pressures are a key determinant of

conflict
Michael Auslin 17, PhD in History from the University of Illinois at Urbana-Champaign, former
associate professor of History at Yale The End of the Asian Century: War, Stagnation, and the
Risks to the World’s Most Dynamic Region, January 2017, accessed via Kindle for Windows - no
page numbers available
The regional demographics that we explored in chapter 3 spill over directly into domestic politics. Next to the failure of economic
How well its
reform, the political challenges facing Indo-Pacific nations are perhaps the largest risk area the region faces.
leaders deal with the demands of their populaces, be they modernized or developing, may be the
most important factor determining the future of the Indo-Pacific. ¶ The real risk from
domestic politics in Asia can be boiled down to one idea: ever since the final Qing ruler
abandoned his ivory-inlaid throne, Asia’s political history has been one of unfinished revolution.
From armed uprisings in Japan in 1867 and in China in 1911 and 1949, through decolonization
in India in 1947 and in Southeast Asia in the 1950s, to peaceful popular revolutions in the
Philippines in 1986 and in South Korea 1987, Asian politics has been one of constant struggle. ¶ It
sounds odd to claim that Asia’s future is still threatened by political revolution. After all, Japan
seems an entirely stable mature democracy, and the Vietnamese and Chinese Communist
Parties maintain an iron grip on power. But economic and social pressures inside all of Asia’s
countries threaten domestic political consequences. ¶ Equally, to turn a popular advertising slogan on its head,
what happens inside a country does not always stay there. An Asia whose political systems fail to provide
stability, legitimacy, and growth is an Asia that will become increasingly troubled. The region’s history
is full of examples of domestic failure leading to wider dislocation. 2 At the same time, embattled
regimes have regularly sought to defuse tensions at home by exporting instability abroad,
even to the point of invading neighboring countries.¶ In looking at the trends in domestic politics
throughout the Indo-Pacific region, this chapter will chart the challenges to democracy and authoritarianism alike. Few
Westerners pay more than passing attention to Asia’s politics. It sometimes may get a minute or
two on the network newscasts, as when Thailand’s military launched a coup in May 2014 or after
the victory of Nobel Peace Prize winner Aung San Suu Kyi’s democratic opposition party in Burma’s
November 2015 election. Yet precisely because so many are not paying sufficient attention, we should be far
more sensitive to the hidden risks that roil domestic politics in the Indo-Pacific. ¶ The question of domestic
political stability leads to the larger issue of the future of politics throughout the region. Americans, whose nation originated in a war
of independence from a European colonial empire, see the spread of democracy as a natural condition. They believe that, given the
choice of self-determination or servitude, any people would prefer to choose their destiny. 3 Economic freedom and opportunity are
believed to follow naturally from and be guaranteed by political freedom. The collapse of the Soviet Union and the rapid
democratization of eastern Europe in the 1990s only reinforced the American belief in the ultimate victory of democracy. 4 While
most Americans understand that political development is not that simple, the moral superiority of democratic governance remains
an article of faith. Even in the face of frequent domestic political gridlock and economic crises, Americans still assume democracy is
a universal good toward which most peoples on earth aspire. To acknowledge this ideological predisposition is not automatically to
deny its validity.¶ Yet the Indo-Pacific continues to confound American understanding of the natural path of political development.
From totalitarian North Korea to authoritarian China on one side of the spectrum and from India’s dizzying democracy to Japan’s
often sclerotic politics on the other, Asia incorporates nearly every type of government known to humanity. Freedom and despotism
continue to battle for Asia’s political soul in another facet of unfinished revolution. ¶ It
is on this battleground that the
future of the Asia-Pacific will take shape. If democracy proves successful at dealing with its
domestic troubles, it will save its legitimacy, gain adherents, and more likely ensure that it
becomes the norm throughout the region. But if smaller states waver in their commitment to
democracy, the triumph of illiberal political regimes may be assured, and the influence of
power politics correspondingly will grow.

Nuke war
Michael Auslin 17, PhD in History from the University of Illinois at Urbana-Champaign, former
associate professor of History at Yale The End of the Asian Century: War, Stagnation, and the
Risks to the World’s Most Dynamic Region, January 2017, accessed via Kindle for Windows - no
page numbers available
the Indo-Pacific region
How close is Asia to seeing conflict erupt, and where? Not every dispute threatens peace, but today,
is regressing to a nineteenth-century style of power politics in which might makes right. With
the world’s largest and most advanced militaries other than the United States, and including
four nuclear powers, a conflict in Asia could truly destabilize the global economy and spark a
conflagration that might spiral out of control.¶ If you are lucky, you might be near Pearl Harbor in Hawaii
when one of America’s aircraft carriers is in port. One afternoon not long ago, I watched the USS Ronald Reagan slowly steam out of
Pearl Harbor into the vastness of the Pacific Ocean. The Ronald Reagan is an apt symbol of how security risk has been managed in
Asia: the United States has underwritten regional stability since 1945. Today,
however, the post– World War II
order instituted by the United States is increasingly stressed, at the very time when Washington
is finding it difficult to respond to crises in Europe and the Middle East. The economic and political risks discussed
here are not isolated from these security trends. ¶ The immediate cause of rising insecurity is simple: as China has grown stronger, it
has become more assertive, even coercive. Beijing has embraced the role of a revisionist power, seeking to define new regional rules
of behavior and confronting those neighbors with which it has disagreements. Japan and Taiwan, along with many countries in
Southeast Asia, fear a risingChina, as does India, though to a lesser degree. That fear, fueled by numerous unresolved
territorial disputes in the East and South China Seas and by growing concern over maintaining
vital trade routes and control of natural resources, is causing an arms race in Asia. The region’s
waters have become the scene of regular paramilitary confrontations. ¶ These fears and responses are
triggering more assertive policies on the part of all states in the region, which only raises tensions further. At the same time,
governments feel pressured at home to demonize neighbors, encroach on territory, and refuse to
negotiate on security disputes. This is clearly what has happened in recent years in the Sino-Japanese relationship. We
have already gone through two turns of a “risk cycle”: uncertainty and insecurity , driven over the past
decade by China’s growing power and increasingly assertive and coercive behavior, and by the emergence of a de facto nuclear North
Korea. A third turn, to instability, could cause conflict and even war.¶ The “Asian Century”
thus may not turn out to be an era when Asia imposes a peaceful order on the world, when
freedom continues to expand, or when the region remains the engine of global economic growth. What it imposes may
instead be conflict and instability. The nations of the Indo-Pacific and the world must prepare for the
possibility of economic stagnation, social and political unrest, and even armed conflict. The
emergence of those would mark the end of the Asian Century.
 AT: Innovation Solves
NHI causes rationing in healthcare and wrecks innovation- Britain
and Canada proves
Dave Mordo 17. Legislative Council Chair of the National health Association of Helath
Underwriters. 7/25/17. “Single-payer would be a nightmare for Americans”
http://www.washingtonexaminer.com/single-payer-would-be-a-nightmare-for-
americans/article/2629120
Supporters of single-payer claim that it would eliminate wasteful spending and improve the quality of care. The reality is quite
different. Single-payer
systems ration healthcare, slow the development of life-saving drugs and
medical devices, and hamstring economic growth.
Single-payer systems control costs primarily by limiting access to healthcare. In the United
Kingdom's National Health Service, 5 million patients will languish on waiting lists for non-emergency
surgeries, such as hip replacements, by 2019. The president of the country's emergency room doctors association warned earlier
this year that wait times are causing "untold patient misery" and that the NHS is "broken."

In Canada, patients wait more than nine weeks between referral from a general practitioner and
consultation with a specialist. By comparison, American patients wait less than four weeks , on
average. Fewer than 4 percent of Americans who need non-emergency surgeries must wait longer than four months, compared to
18 percent of Canadians.

In many cases, single-payer systems force patients to wait indefinitely for lifesaving medicines —
again, to keep costs down.
For instance, Britain's NHS only permits 10,000 people per year to receive highly advanced drugs
that cure hepatitis C, a deadly infectious disease that afflicts 215,000 Britons.

As of late 2015, the NHS covered just 38 percent of cancer medicines approved for sale in 2014 and 2015. Canada's national health
system offered access to 24 percent of those drugs; Spain's, only 5 percent.

Those medicines that are available are subject to government price controls. Patients may feel like they're getting a good deal, but
such controls discourage investment in medical research, slowing the pace of medical
innovation.
In the 1970s, four European countries developed more than half of the world's medicines . But
since they imposed price controls on drugs, those countries now invent only one-third of
medicines. The United States, by contrast, developed nearly 60 percent of the world's new drugs between 2001 and 2010.
Single-payer systems don't just cap spending on drugs. They also insist upon artificially low reimbursement
rates for hospitals and doctors. In many cases, these payments don't even cover the cost of providing certain treatments
and procedures.

The result? Fewer hospitals and doctors. Canada has about 10 percent fewer hospital beds per person than the United
States — and 35 percent fewer surgeons per capita.
 2NC- MT Interests Low
Search trends and estimates prove interest in medical tourism is low
now
Keith Pollard 16, CEO of Intuition Communication Ltd, web publishing business in the
healthcare sector. Sites include Medical Travel journal, treatment Abroad, Medical Tourism
Portal, DoctorInternet, Arabic Medical Tourism Portal, and Private Healthcare UK, “Declining
Interest in Medical Tourism?” 8-1-2016. International Medical Travel Journal.
https://www.imtj.com/blog/declining-interest-medical-tourism/.
After claims of medical tourism being a billion dollar market, Keith Pollard digs deep to offer an
honest answer on what the medical tourism market is worth and where it's heading.
Last month we heard from the USA that "Medical Tourism Industry Valued at $439B" and is "Poised for 25% Year-
Over-Year Growth by 2025". This month, I see that there's a new report on the "World Medical Tourism
Market" claiming that the world medical tourism market will reach $143.8 billion by 2022, with a CAGR of 15.7%
from 2015 to 2022.

In contrast, Ian Youngman, an independent researcher who writes for IMTJ and has been monitoring the market
for over ten years comes up with his own "best guesstimate". In his latest report, Medical Tourism Facts and Figures
2016, Ian says "I would put it at between $5 billion and $7 billion." Ian is probably much nearer the mark than the
$143.8 billion or the $439 billion.

The honest answer is that nobody actually knows. But the hype continues. My favourite quote of the week, on the
market size issue, emanated from an MTA webcast "There's a lot of crap out there", said the presenter. Given that the
presenter's business is making the most of publicising the latest inflated market estimates, I felt it was a little contrary.

So, is there anywhere else we can look to get an idea of how this business sector is developing?

What does Google say about medical tourism?

If you want to know who's going to win one of those reality TV shows that go to a public vote, then Google can probably tell you.
Because interest displayed via Google searches gives you a very good idea of voting patterns. When it comes to interest in medical
tourism, can Google tell us anything about the sector?

Google Trends is a great tool for looking at "what's hot" and "what's not", keeping track of what people
want to know about, and how interest in market sectors, products and topics changes over time. The data analyses over
100-billion searches made every month on Google, and can be tracked back over many years.
Savvy marketers are making increased use of Google Trends to identify patterns in consumer
demand and assess the development of new markets.
So what does Google Trends tell us about medical tourism?
Here is a graph of "interest over time" for the search topic "medical tourism" from 2004 until now.

Interest in the topic peaked in November 2006... ten years ago.

Since March 2009, interest in the topic has seen a steady decline. The current level of interest is
around 40% of what it was at its peak.
So, should we be worried about this? Probably, yes. You
could argue that medical tourism has now become widely
accepted and is the norm, so people don't search to find out about it anymore. I don't buy that. Or is it an
example of a market sector that attracted a great deal of interest and then has failed to take off ?
Search trends for related terms
Search volumes for related topics and terms have seen a similar decline. Whether it's "medical tourism",
"medical travel" or "health tourism" the trend is downwards. The graph below shows the last ten years. I've left "wellness travel" and
"wellness tourism" off the graph because the numbers are very small. Medical travel comes out top overall.
 Bioterror D---2NC
No bioterror impact:
1. Empirically denied---every past attempt has been super small
and failed---zero basis to assume magical increases in capability
2. Tech barriers---scaling up, storage, and dissemination are all
impossible---ability to design the weapon doesn’t translate into
large-scale deployment---that’s Lentzos
No bioterror impact---diagnosis period, antibiotics, difficult, and
surveillance solves
Hugo-Jan Jansen 14, Ph.D. in Oral Microbiology, Senior advisor at Netherlands Ministry of
Defense, May 2014, “Biological warfare, bioterrorism and biocrime,”
https://www.researchgate.net/publication/262773383_Biological_warfare_bioterrorism_and_
biocrime
So far, bioterrorism has claimed few lives as compared with the more traditional forms of
terrorism using guns and explosives. The risk that use of the infectious agents as selected in Table 1 will
result in casualties is real, but also should not be overestimated. For example, natural variations in
incubation period, as can be seen from Table 1, will usually allow for diagnosis before the peak of
symptomatic cases for most of the agents (and the longer the incubation period, the more this is so). Then, unless a
multiresistant but highly aggressive ‘superbug’ is envisaged, effective antibiotics are available for the majority
of bacterial agents at least. Nevertheless, there is some reason for concern that future bioterrorism attacks may be more
effective than incidents in the past. Terrorists will usually use readily available weapons, but some also
will keep trying to adopt tactics to inflict mass casualties to achieve ideological, revenge or
religious goals. Sects such as Aum Shinrikyo have tried to master the method of aerosol dissemination of biological agents. Al-
Qaida sought to acquire biological weapons [53]. Many of its assets in Afghanistan may have been destroyed in the past decade, but
its aims and motivation have probably not changed. Also, because of increasing technological innovation and sophistication of
equipment, and the proliferation of knowledge through the Internet across the world, equipment has become cheaper, smaller, and
easier to operate, and methods have become easier to execute. What once required an expensive laboratory may now be done by a
skilled individual in a garage, and will be difficult to prevent or detect. Laboratories have oversight mechanisms, colleagues peering
in, and preventive measures in place to protect workers and the environment against inadvertent releases, but this is not the case in
the do-it-yourself (DIY)-type garage box biology. Beyond doubt, in almost all cases the ingenuity and creativity displayed by these
researchers and engineers is fully transparent within the community, and will be applied for beneficial purposes. Ultimately, it may
result in biofuel-producing bacteria, lighting from luminescent microorganisms, or even biological computers [54]. The
dual-
use nature of life sciences technology and the diffusion of advanced technological capabilities
could facilitate the development of a biological weapon, including mechanisms for effective dissemination.
However, it must also be noted that, although equipment and techniques have become more readily
available, considerable skills and expertise are still required to carry out this kind of
DIY research [55]. The likelihood of rogue individuals carrying out DIY biology is real, but small.
Self-regulation and transparency of DIY biology research should be encouraged. Possibly more disturbing for the future, some
terrorists might gain access to the expertise and or agents generated by a state-directed BW programme. Civil war, revolt and
lawlessness in countries possessing such a BW programme would cause a significant proliferation risk.

On the bright side, the technological innovations and rapid advances in life sciences have greatly
increased our understanding of the ways in which pathogens interact with the host, and have
stimulated the development of medical countermeasures. It must be stated that the benefits
for society provided by these advances far outweigh the potential adverse effects . Also, they have
greatly increased our abilities to detect and identify pathogens in a timely manner. At the same
time, technological advances such as networked video cameras and software designed to identify
important intelligence information have become powerful tools for counterterrorism operations,
and have increased the effectiveness of antiterrorism countermeasures in order to prevent
attacks. In the USA, the majority of bioterrorism attempts [21,43] were foiled in the early stages,
indicating the success of the surveillance and counterterrorism activities. Technological
advances have resulted in an increase in our forensic ability to investigate an incident and track
down the origins.

Terrorists lack tacit knowledge so they can’t deploy the technology

effectively
Filippa Lentzos 14, PhD from London School of Economics and Social Science, Senior Research
Fellow in the Department of Social Science, Health and Medicine at King’s College London,
Catherine Jefferson, researcher in the Department of Social Science, Health, and Medicine at
King’s College London, DPhil from the University of Sussex, former senior policy advisor for
international security at the Royal Society, and Dr. Claire Marris, Senior Research Fellow in the
Department of Social Science, Health and Medicine at King's College London, Synthetic biology
and biosecurity: challenging the "myths". Front Public Health. 2014 Aug 21;2:115,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4139924/
Synthetic biology, a field that aims to "make biology easier to engineer," is routinely described as leading to an
increase in the "dual-use" threat, i.e., the potential for the same scientific research to be "used" for peaceful purposes or "misused" for
warfare or terrorism. Fears have been expressed that the "de-skilling" of biology, combined with online access to the genomic DNA
sequences of pathogenic organisms and the reduction in price for DNA synthesis, will make biology increasingly accessible to
people operating outside well-equipped professional research laboratories, including people with malevolent intentions.
The emergence of do-it-yourself (DIY) biology communities and of the student iGEM competition has come to epitomize this
supposed trend toward greater ease of access and the associated potential threat from rogue actors. In this article, we identify five "myths" that
permeate discussions about synthetic biology and biosecurity , and argue that they embody misleading
assumptions about both synthetic biology and bioterrorism. We demonstrate how these myths are
challenged by more realistic understandings of the scientific research currently being conducted
in both professional and DIY laboratories, and by an analysis of historical cases of bioterrorism . We show that the
importance of tacit knowledge is commonly overlooked in the dominant narrative: the focus is on
access to biological materials and digital information, rather than on human practices and
institutional dimensions. As a result, public discourse on synthetic biology and biosecurity tends to
portray speculative scenarios about the future as realities in the present or the near future, when this is
not warranted. We suggest that these "myths" play an important role in defining synthetic biology as a "promissory" field of research and as
an "emerging technology" in need of governance.