My Debate Team Affirmative

[Yanny]

I am writing this to help me and my partner along with our first debate meet on 1/7/03. I ask for constructive analysis of the debate, and for you to act as the negative. Keep in mind, I automatically assume this will be passed by Congress, and any terms which I define you (the Negative side) must adhere to. Try not to argue the idealogy, however try to argue like you were in front of an unbiased judge, trying to win the debate.

Resolved: The United States Federal Government should substantially increase Public Health Services for Mental Health Care.

Let me start off by defining some terms. First off, “Substantially” means any real number. I define Public Health services as laws or agencies which make health care available to the masses.

Here are the basics of my plan (Its actually a speech, but I won’t bother to type that whole thing out).

Autism is one of the most debilitating diseases existing in the world. It consists of damage to the learning center of the brain. It cannot be prevented, but it can be cured. Autisim can be detected at an age as early as 18 months, earlier for some children. Toddlers with Autism will usually just be unreactive, slow learning, or unwilling to make eye contact. Over the past 30 years, according to the Autism Society of America, Autism cases have increased by 200% since 1975. It is a growing problem and must be addressed. Autistic patients, left untreated, usually develope mental retardation.

However, Autism grows much more serious as the person grows older. An Autisic child, remaining untreated, falls more and more behind every year. By the time they are adults, and still untreated, they become a public liability and can not function as productive members of society.

However, Autism is treatable. Treatment consists of progressive one on one contact with a Psychologist. The Psychologist teaches the patient skills, skills which help the patient to learn. Along with short term medication, the patient can be completely cured in under 3 years.

However, such treatment is incredibly expensive. According to the New York Guidelines for diagnosing and treating Autism, “Autistic treatment consists of 3 to 6 visits with a well trained Psychologist every week”. Now, the average Psychologist (according to World Health Insurance company) charges 125$ per hour for such visits. Every year, this means an Autistic Patient is going to be spending about 54,000 dollars. This does not include other special services, such as transportation, that the afflicted child will require.

Right now, insurance companies are only required to pay 50% of Mental Health Care costs. This means that the average family will have to pay 27,000 dollars a year to treat their Autistic child. Considering that the average American makes only 55,000 dollars a year (according to Cia.gov), this price most often cannot be payed and the child is left untreated.

Our plan would pass a law requiring patients to only pay 15% copayments, and insurance companies must cover the other 85% of costs, to all Autism treatment related charges. This would give patients the ability to receive treatment at an affordable cost.

According to The Center for the Study of Autism, “There are about 400,000 Autistic untreated people in America. This is a conservative estimate”. About 280,000 of these have Medical Insurance. However, most go untreated.

The burden of funding would be placed upon the Insurance Companies of America. This would mean a very small increase in Insurance rates, if the company decides to increase the rates at all. Assuming every single company decides to increase rates to fit the added cost, this adds a 12,852,000,000 price tag. This may seem like a lot, but shared by the 196,000,000 Americans with Medical Insurance, comes out to about 65 dollars per year per person. That is about 5 dollars per month.

That 5 dollars per month should be considered an investment. According to a study done by the British Government, it costs about 1 Million pounds to educate an untreated Autistic patient from K-12. Thats about 1.5 Million dollars over 13 years. Compare that to 45900 (15% payed by Patient, 85% by insurance company), for 3 years that will cost to treat this Autistic children. If detected early, treatment can be finished before a child enters first grade.

In conclusion, Autism is an easily solved problem. Without Insurance coverage, the costs for treating Autism are too unreasonable to be a viable option for parents. When a severly Autistic child enters school, the schools are given a massive burden which they cannot directly treat. This costs a lot of money. This plan will cut that burden from schools, at minimal cost to the average America at first, and later will actually make that money up via increased productivity.

Thanks, now I will entertain any questions.

[cystic crypt]

So the net treatment costs are $54000x3 years + time spent away from work to take kids to the shrink by parents.
You missed the big questions. What is the efficacy rate of this “proceedure”? (i.e. how many patients treated this way will be “cured” or “successful treatments”? And to what extent? Increasing an adults I.Q. from 65 to 68 may be a questionable “outcome”. What are the “numbers needed to treat”? If we treat 8 people and get a positive outcome in 1 that is better than a 50-1.
Have any studies been done looking at health outcomes of treated autistic pts relative to non-treated as well as non-autistic patients? I.e. what is the difference in health - admissions, treatments, prescriptions, complimentary medicine treatments of autistic children relative to the other 2 sets? (this may not matter in the US where you rely on private payers more, but in Canada it’s an important part of the puzzle for policy setters as if a utility can be shown IN ADDITION to demonstrating efficacy of treatment, ethics of treatment etc., then it goes further to persuading the ministry of Health to provide increased funding).
Studies done on comparing lost wages/lost productivity OF PARENTS as well as the autistic children (relative again to those of non-treated and non-autistic)?
Also i think that sometimes bureaucracies miss the boat on who pays for what. Should not the Educational system foot the bill? (the question here is “how much do autistic children “cost” the education system over their k-12 experience”?)
Obviously these are the simplest measurable outcomes and can not possibly deal with the unmeasureables - i.e. the Parents’ lives dealing with an autistic vs. a “normal” child. One might look at quality of life for the parents, as well as hours lost in productivity - if this could be determined then employers might well select insurance companies that provided a “broader plan”.
Anyway, just some things off the top of my head to think of. These issues may help finesse your arguments, particularly when dealing with someone who may know some of the answers to these . . . .

[Yanny]

Ah, good point,

46% of Autistic patients, after undergoing 3 years of treatment, are able to function as normal members of society. Another 41% of those treated showed “significant increases” in functionality level. Thats an 87% success rate.

The Educational System does not pay for any treatment of Autism. However, Autistic patients require intense special education programs. About 30% require their own personal attendent for the whole school day.

The lost productivity statistics (My partner has some exact ones, I’ll get those to you tomorrow), are base upon Adult Autistic patients, along with Parents missing time to take children to these daily visits. Adult Autistic sufferers usually cannot hold a job, and become dependent upon public money (Welfare, Medicaid, ect).

[cystic crypt]

sorry to not provide an appropriate negative argument.
It looks like you’re getting your stats firmed up nicely. These are some things to consider in pharmaco-economics.
If you can firm up any other “stats” - for example:
People with Autism end up visiting physicians x times/year more than people without, and and up costing the medicare system $y/year more than people without. Furthermore, if one considers the avg income of a US citizen to be $50 000 and the autistic US citizen to be $10 000 blah blah blah.
I think i could argue much more in favor of this then against, but i’m sure that the Fraser Institue or some Taxpayers federation could present better counter-arguments.

[Yanny]

Well, those stats are not easily available. My partner has some, I have none. Autism is not a theme I’ve seen often this year. We’re hoping to catch the negative off guard with it.

[cystic crypt]

i’d be impressed if you actually had those stats.
i guess you could make some up . . . :lol:

[Yanny]

My mother helped write the New York Guidelines on Autism. She pointed me to quite a few sources :)

[bossk]

Well, let’s see what I can come up with opens big box o’ evidence, pulls Autism file first, since you were sneaky and denied me any real chance of a topicality I’d run an attack on your harms saying there is a problem with diagnosing autism, then an inherency attack based on the status quo is already solving, then I’d run a federalism disadvantage and maybe a stigma DA on top of that. Sorry if I don’t really want to take the time to type out all my evidence, but obviously, looking at it right now, I think the federalism DA will give you the most trouble. that’s really novel, how you denied me most of my topicality arguments though.

[cystic crypt]

Psychiatry has come a long way since Freud. I think it now is arguably as “scientific” as any other medical discipline. I’ve included the DSM IV criteria for Autism and Pervasive Developmental Disorders. This might come in handy if anyone challenges you on “diagnostic featues”. (i assumed you had access to this, but figured it might be handy . . . always carry the DSM IV on you - you never know when you need a quick psychiatric diagnosis - i’m looking at you Mr. Ghoul - i’ve got you pigeonholed into a few categories :D

DSM-IV Criteria, Pervasive Developmental Disorders
299.00 Autistic Disorder
A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

(1) qualitative impairment in social interaction, as manifested by at least two of the following:
(a) marked impairment in the use of multiple nonverbal behaviors, such as eye-to- eye gaze, facial expression, body postures, and gestures to regulate social interaction
(b) failure to develop peer relationships appropriate to developmental level

© a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)

(d) lack of social or emotional reciprocity

(2) qualitative impairments in communication, as manifested by at least one of the following:
(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

© stereotyped and repetitive use of language or idiosyncratic language

(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities as manifested by at least one of the following:
(a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(b) apparently inflexible adherence to specific, nonfunctional routines or rituals

© stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting or complex whole-body movements)

(d) persistent precoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.
C. The disturbance is not better accounted for by Rett’s disorder or childhood disintegrative disorder.

299.80 Pervasive Developmental Disorder, Not Otherwise Specified

This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific pervasive developmental disorder, schizophrenia, schizotypal personality disorder, or avoidant personality disorder. For example, this category includes “atypical autism” --presentations that do not meet the criteria for autistic disorder because of late age of onset, atypical symptomatology, or subthreshold symptomatology, or all of these.

299.80 Asperger’s Disorder

A. Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
(2) failure to develop peer relationships appropriate to developmental level

(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)

(4) lack of social or emotional reciprocity

B. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(2) apparently inflexible adherence to specific, nonfunctional routines or rituals

(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

(4) persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific pervasive developmental disorder or schizophrenia.

[Yanny]

Yes, I do have access to the DSM. In fact, its right in front of me.

Well, let’s see what I can come up with opens big box o’ evidence, pulls Autism file first, since you were sneaky and denied me any real chance of a topicality I’d run an attack on your harms saying there is a problem with diagnosing autism, then an inherency attack based on the status quo is already solving, then I’d run a federalism disadvantage and maybe a stigma DA on top of that. Sorry if I don’t really want to take the time to type out all my evidence, but obviously, looking at it right now, I think the federalism DA will give you the most trouble. that’s really novel, how you denied me most of my topicality arguments though.

Ok, Bossk, I’m pretty green to debating. This is my first debate. Can you help define some terms for me? Like, Topicallity Argument (I have a slight idea of what it is, but it could use some explaining). Also, whats an inherency attack?

[bossk]

No problem Yanny; after a few rounds you’ll be pretty comfortable with the basic stock issues of debate. First of all, there are probably about 4 parts to your case: your significance/harms, that say how many people are affected and basicly outlines how bad the problem is, the inherency, which tells us what is wrong with the status quo hence causing the harms, your plan, which says exactly what you’re going to do (funding, enforcement and the like), and the solvency, evidence that says how the stuff in your plan solves. By attacking your inherency I’m saying that the status quo already solves for your harms, therefor your plan is unnessicary. A topicality argument says that your case or plan is not related to the resolution. It usually consists of a definition of one of the words in the resolution, an explanation of why your case does not meet that definition, and why the judge should vote on topicality. I hope this helps. If it is at all confusing then just forget about it, I’m sure your coach will prefer explaining it to you himself rather than have you be confused.

[Yanny]

Problem is my debate coach retires in 2 days :(

[bossk]

That’s not good. Does your team have a replacment? I’d be glad to help you out the best I can, although I’m not sure how well I can do. This is my first season too, only our season started in mid-November. But if you ask me, I know some top-notch guys who could probably provide answers if you need them :wink:

[Yanny]

I think so, though I don’t know who he/she is. I think I can manage. Problem is, my Negative is weak.

Well, guess I have 3 weeks to work on that. Got 3 more negative handbooks to read.

[ZimZaxZeo]

If I were arguing against you, I’d aim first at a few fundamentals… let’s see:

1. I would first go right to the root, and attack your assertions about “curing” this neurological disorder. Along the way, I would plant a few doubts in the judge’s mind that Autism is a “mental” disorder that can be obviated by psychiatric counseling and some meds. I would continually drop hints – and bring in expert opinions complete with images of brain scans from patient studies – that Autism is mainly a physical deformity of brain function, and that real improvement, limited though it may be, is mostly gained through the application of drugs, that any impression the medical community has of counseling and/or behavior modification as the path to cure is more or less wishful thinking. (What a bastard I’d be!)

Along the lines of cystic crypt’s initial queries, I would declare that improving the lot of 87% of patients sounds great – but is not so great when the mitigation of their condition is relatively minor, as he suggested in supposing that it might raise IQ scores “from 65 to 68.”

So much for the “cure.”

2. Now I would flip my argument, and show that there really has been some “curing” of Autism – and that it has been accomplished mainly by the government funding for special education services, and by Medicaid, etc. Here come the statistics and expert testimony that public health services have indeed done the best, most cost-effective socially responsible job in treating and mitigating the effects of autism.

But wait – does it sound like I’m agreeing with you? Only if you blur the distinction between “public health services” and “insurance companies.”

My real thrust in this argument is to stick the public schools and daycare centers with the burden. I would raise a major, major stink challenging why should insurance companies be mandated to pay for the treatment of any Autistic patients, above and beyond any amount these private enterprises already are saddled with. I would show statistics and my treasured actuarial tables that illustrate a world where having my beloved insurance companies paying 50% of the treatment cost is already a huge burden that qualifies these companies as the veritable Mother Theresas of the corporate universe.

I would make a big statement, again supported by experts, that adding 35 %age points to this burden would actually counteract the good work being done, by eroding the insurance companies’ ability to pay for the drugs, to compensate truly qualified shrinks, etc. They would have to slash the quality of the treatment – thereby harming the welfare of the patients – in order to meet the unsupportable burden of taking on a greater quantity of patients (your argument already states this would happen) while being forced to pay a much greater share of the treatment for each one treated. Some of these corporate good citizens might even be forced out of business, further reducing available resources for Autistic patients.

This is the practical, cold-hard facts part of the argument. Now I swing into pragmatics: “Your honor, we want the greatest good for the greatest number. But in a case of such scope and need, only the federal government can accomplish that, and only by developing the already superior program that exists within the publically funded daycare and school system, through special ed programs, etc.” Of course, the big insurance combines, being the leaders of mankind that they are, would graciously step forward to serve on boards and tell the education bureaucrats how to spend the $12 billion in new federal funds.

I would close by beating the drum for this wonderful match made in heaven: public money, private direction on where and how to spend it. (My first argument, that success in treating Autism is really due to drug regimes, will be alluded to in closing, as I note that by far the best way to administer daily drug doses to kids is to get the school nurse to supervise it! What Johnny needs is not $125/hr. invididual psychiatric mumbo jumbo, but $20/hr. school nurses who can dispense pills to 300 kids! Ah, the public schools: the universal panacea.)

Well, there’s my cynical go-for-the-jugular negative. If you have further questions, I could refer you to my colleague, Dr. Mengele.

[cystic crypt]

any further discussion on ZZZ’s point can be found in my Community Health Sciences Health Policy paper on privatization of the medical system in Canada . . . .

[Yanny]

Couple points -

1. First, we are increasing the availability of treatment for Autism. That solves our resolve, because substantially is defined as “any real increase”.

2. Next, Autism treatment has an 87% success rate (wish I had the stat sheet on me, my partner has it at the moment).

3. Next, this plan will actually lessen the burden on schools. It costs a lot of money to educate an Autistic child for 12 years, upwards of 1,500,000 dollars (according to a study done by the Autism Society of America). It only takes 3 years of treating Autistic children to cure them, at 54,000 dollars a year. Thats only 162,000 dollars, a huge savings.

4. Autism is a classified as a mental disorder, according to the DSM.

5. The number of 400,000 people with Autism in America (from the New York State Guidelines on Autism) only count “people who are significantly impared by Autism”.

[ZimZaxZeo]

@Yanny:

Resolved: The United States Federal Government should substantially increase Public Health Services for Mental Health Care.

Right now, insurance companies are only required to pay 50% of Mental Health Care costs.

Our plan would pass a law requiring patients to only pay 15% copayments, and insurance companies must cover the other 85% of costs, to all Autism treatment related charges.

The burden of funding would be placed upon the Insurance Companies of America. This would mean a very small increase in Insurance rates, if the company decides to increase the rates at all. Assuming every single company decides to increase rates to fit the added cost, this adds a 12,852,000,000 price tag.

Whatever other smokescreens I might use, my “negative” will relentlessly hammer away at the private vs. public funding & administration question in the solution to your otherwise eminently logical proposal.

As we are not speaking about a country with a nationally socialized medical insurance program (and though on this point I may envy my brothers to the north), it comes down to who should and will pay. And I believe I can make the case (as I am taking the position of a lobbyist for the healthcare insurance industry) that spiraling costs of healthcare – prescription drugs, physician and psychiatric liaison, reimbursement bookkeeping and record management, patient services, etc., etc., etc. – have already pressed our fine industry to the breaking point. Some very well run companies, exemplars of our sacred system of free enterprise, would go bankrupt if forced to take on this added burden.

What those who propose this proposal do not understand is that the insurance industry is already subsidizing even the paying of 50% of costs to treat Austism. We shift much of the real cost in order to provide these treatments to these deserving patients. But $12.9 billion is no small uptick in expenses! We are literally talking bankruptcy here, because the Federal Govt has been and will continue to cut back on Medicaid and other special reimbursement funds – not increase them – and there is enormous additional burden upon the healthcare industry in attempting to recoup such costs.

Increasing payments from 50% to 85% is a 70% increase in cost! (35/50 = 0.70)
What other industry would be asked to increase their cost burden per client by 70% – and at the same time to dramatically increase the number of clients they serve?

If the Federal Funds are not forthcoming – and sadly, they will not be, not in this time of repeated tax cuts, budget deficits, a recession-mode economy, more unemployment, and a call from the highest levels of government for shifting of education, healthcare and welfare costs to private charities – then this $12.9 billion burden will fall upon an industry already under huge pressures. And then who will suffer? Well, the patients and their families and their communities!

The quality of care will actually diminish for each individual patient, because the healthcare industry will be forced to spread current resources to care for many more patients. With this decline in quality of care, the rate of a complete treatment cycle of three years will no longer hold up. And then we will see the burden shift to the only place it can – upon the schools, already under great duress to sustain special education programs. Thus the federal government would be at a disadvantage, running a triage operation as under-treated patients bog down the resources at unprepared schools.

A better solution is to increase the service level in the schools to begin with! Each federal dollar spent in the public daycare and school environment goes much farther per patient than a dollar spent through the insurance reimbursement system. Let us not penalize the patient! Let us increase and improve the care level in the schools!

Bleah blah I rest my case etc.
Ciao for now

[cystic crypt]

what will happen, ZZZ, is that as premiums increase, several things will happen.

1. People with fewer disabilities/risk factors will be charged such small premiums, and people with disabilities/risk factors will be charged high premiums
   OR
2. People who have few risks and/or disabilities will opt out of insurance plans as they increase.
   These will have the effect of fewer people paying much more for insurance to the extent that insurance would become relatively pointless - people would be (roughly) paying for their health care, plus the layers of administration, marketting, company cars, etc. that the insurance company requires.
   This is one major reason for sociallized health care up here.

[ZimZaxZeo]

I yam hep to dat, good buddy!

But would the judge buy such an argument from the Positive side in Yanny’s case? The insurance industry lobbyist is going to stick to his guns. After all, he likes getting that new company car every two years, to treat as his own, not to mention the stock options, etc. Oh, and he has the best health insurance money can buy, too – but it’s not his money that’s paying for it!

(Why I didn’t go into corporate lobbying as a career is beyond me!)

Another thing that you can add to your list:

3. millions of people will show up in ERs with conditions that could have been treated and should be treated through multiple-times-less expensive regular preventive and diagnostic care – because they are uninsured. Can you say “cost shifting?” whereby hospitals must charge the insured with $40 aspirins.

…where is Hippocrates when we need good strong advice?