Heg Aff
Heg Aff**Obesity internal links – medicare solves for it** Also just not having preventative treatment bars people from the military **Soft Power and diplomacy – science diplomacy? CDC credibilityGeneralUQ – Readiness lowMilitary officials warn against American ability to combat superpowersRowan Scarborough, 16. 3-27-16. (Scarborough: Staff Writer. “US Military’s Ability to Fight Major Overseas War in Doubt” Washington Times. Accessed 8-1-17. JSD.)Meanwhile, Congress will continue to hear testimony like this: “So half of our combat Air Forces are not sufficiently ready for that kind of a high-end fight against one of those great powers,” said Air Force Secretary Deborah Lee James. “We have never been busier on such a sustained and global basis,” she added, “and we are doing all of this with roughly 200,000 fewer people and 79 fewer fighter squadrons than we had at the time of Operation Desert Storm. So we are a much, much smaller Air Force. We have been downsizing for years, and our people are very stressed and this simply needs to stop.” Gen. Milley said the Army is ready to fight the Islamic State, al Qaeda and other international terrorist groups, but he worries about the ability to fully fight China or Russia, or Iran or North Korea, as the National Military Strategy says the Army must be ready to do. “Right now, the readiness of the United States Army, all components of the United States Army, is not at a level that is appropriate for what the American people would expect to defend them,” the four-star general testified. As for the great social challenge facing the armed forces — the introduction of women into direct ground combat — the topic hardly came up during hours of what are called “posture” hearings.Military currently undergoing readiness problemsNational Security News, 16 9-14-16. (“The Pentagon has a Readiness Problem it Still Hasn’t Fixed”, National Security News. Retrieved from: 9-27-16. JSD)DoD has stated that readiness rebuilding is a priority,” Pendleton’s report said, “but implementation and oversight of department-wide readiness rebuilding efforts have not fully included key elements of sound planning, putting the rebuilding efforts at risk.” The GAO said the service branches have not defined what readiness means or how progress will be measured, nor have they determined what resources are needed to reach those goals. Moreover, the Defense Department hasn’t fully considered “external factors such as maintenance and training on readiness rebuilding goals.” By not including these “key elements of sound planning into recovery efforts, and amid competing priorities that the department must balance,” the report said, “successful implementation of readiness recovery plans may be at risk.”UQ – Global CrisisMilitary Readiness is needed now – global instability lurks.Daniel Wiser, 15. 2-24-15. (Wiser: . “U.S. Military No Longer Able to Fight To Wars at Same.” The Washington Free Beacon. Accessed 8-1-17. JSD)The report said the Air Force was in the best relative condition of the services. The size and readiness of the U.S. armed forces are declining during a period of global instability not seen since the Cold War. The report said the threats to U.S. vital interests are "elevated" from Iran, Middle East terrorism, and North Korea. The threat levels are even higher from Russia and China, according to the think tank. Russia "possesses the largest nuclear weapons arsenal among the nuclear powers (when short-range nuclear weapons are included)" and has demonstrated a willingness to harm U.S. allies in Europe—as evidenced by its ongoing destabilization of Ukraine. China has been modernizing its nuclear and conventional forces in recent years and "is taking increasingly assertive steps to secure its own interests in [the Asia-Pacific region] independent of U.S. efforts to maintain freedom of the commons for all." The report also expressed concerns about the state of U.S. nuclear forces. Defense officials are not developing any new nuclear warheads, and weapons and delivery vehicles are not replaced for long periods—heightening the risk of failure. "Nearly every other nuclear power is carrying out a modernization program that involves warhead and delivery system upgrades," the report said.SomethingReform of healthcare key to the military crisisJohn Kokulis 13. 10-17-13. (Kokulis: Board of Directors for Gold coast Veterans Foundation. “Preserving the Military Health Care Benefit: Needed Steps for Reform.” American Enterprise Institute. Accessed 8-1-17. JSD.) Rapid Cost Escalation DoD’s total medical costs have more than doubled, from $19 billion in fiscal year 2001 to $48.7 billion for fiscal year 2013.13 Growing faster than DoD’s overall budget, these costs now make up close to 10 percent of DoD’s total budget, whereas they represented only 5.9 percent of the total back in FY 2001. (See figure 1.) Left unchecked, the problem is forecasted to get worse. In a 2012 report, the Congressional Budget Office (CBO) estimated the military health care budget will jump to $65 billion by 2017 and to $95 billion by 2030.14 CBO is not alone in its concern. Since 2007, the Government Accountability Office (GAO) has identified concerns regarding the sustainability of military health care benefits and recommended that Congress consider restructuring military compensation.[15] The consensus surrounding military health care reform runs even deeper. Numerous independent panels, commissions, and organizations, including the Quadrennial Review of Military Compensation, the Defense Business Board, the Quadrennial Defense Review Independent Panel, the Center for American Progress, the RAND Corporation, the Heritage Foundation, and the Center for Strategic and International Studies, have all agreed that serious reform is imperative. Although these groups and organizations are often bitterly divided on many issues, one thing they have in common is the belief that the status quo is unsustainable.Impact – ReadinessReadiness remains crucial to global stabilityRichard Dunn, 13 7-18-13 (Dunn: Senior Research Fellow. Consultant on international security affairs. He is a retired army colonel. “The Impact of a Declining Defense Budget on Combat Readiness.” The Heritage Foundation. Accessed 8-1-17. JSD)Regrettably, world events and potential threats to U.S. strategic national interests are not driven by the same forces that drive the political and budgetary gridlock in Washington. North Korea’s increasingly bellicose rhetoric and actions endanger regional stability in the economically vital Western Pacific. The maelstrom of conflict in Syria threatens to engulf its neighbors as Iran continues to pursue a destabilizing nuclear capability in the Middle East. The one-word descriptor for our strategic situation is “uncertain.” Under these conditions, allowing the readiness of our armed forces to decline is extremely unwise. Despite major political and legislative challenges, maintaining balance among the different dimensions of readiness should be a major goal of our defense policy, and defense resources should be apportioned accordingly. Even as defense budgets decline, we need to recognize that imbalances among the personnel, equipment, and training dimensions can weaken readiness as much as or more than the reduction in overall defense spending can. To fulfill its obligations for national defense, Congress needs to maintain full awareness of the different dimensions of readiness, present and projected, and the relationships among them as the Defense Department navigates through the budget crisis. This will require a deeper look into readiness than is currently provided by the formal military readiness reporting system. It necessitates a more holistic understanding of how apparently unrelated changes in one dimension may have a longer-term and more far-reaching impact in others.Readiness key to response time to warRichard Dunn, 13 7-18-13 (Dunn: Senior Research Fellow. Consultant on international security affairs. He is a retired army colonel. “The Impact of a Declining Defense Budget on Combat Readiness.” The Heritage Foundation. Accessed 8-1-17. JSD)Although we know that the future may hold significant dangers, they remain ill defined, creating a challenging analytical problem for national security policymakers. History can provide useful insights into how to approach strategic uncertainty. We know we cannot “get it entirely right.” Therefore, we should strive not to get it so far wrong that we suffer unacceptable consequences when hit by unexpected threats. Under conditions of uncertainty, a hedging strategy that provides a range of options makes the most sense. Historically, maintaining effective balance among the different dimensions of readiness and having some ready capability to deal with a wide range of potential threats have been an effective way to hedge strategic bets. In times of defense budgetary retrenchment, combat readiness of the armed forces often becomes one of the first casualties of fiscal tightening. This was particularly true of the years between World War I and World War II, when the Great Depression and isolationism made military preparedness a very low national priority. Despite the threatening war clouds rapidly expanding in Asia and Europe, the U.S. was woefully unprepared for global conflict. The shock of Pearl Harbor mobilized both the industrial capability and the moral determination to overcome the early, disastrous reversals in the Pacific and tactical defeats in North Africa. Once focused on military production, the U.S. economy rapidly produced overwhelming quantities of ships, aircraft, tanks, ammunition, and other matériel needed for America to become the “Arsenal of Democracy.” However, U.S. forces quickly learned that training for combat, particularly in developing military leaders, was just as complex and demanding.Military readiness is key to preventing war.Spencer 2000(Jack, Policy Analyst - Heritage Foundation, The Facts About Military Readiness, 9-15, )Military readiness is vital because declines in America's military readiness signal to the rest of the world that the United States is not prepared to defend its interests. Therefore, potentially hostile nations will be more likely to lash out against American allies and interests, inevitably leading to U.S. involvement in combat. A high state of military readiness is more likely to deter potentially hostile nations from acting aggressively in regions of vital national interest, thereby preserving peace.Readiness uniquely prevents nuclear warKagan, 7 (Robert, senior fellow at the Carnegie Endowment for International Peace, “End of Dreams, Return of History”, 7/19, )The jostling for status and influence among these ambitious nations and would-be nations is a second defining feature of the new post-Cold War international system. Nationalism in all its forms is back, if it ever went away, and so is international competition for power, influence, honor, and status. American predominance prevents these rivalries from intensifying — its regional as well as its global predominance. Were the United States to diminish its influence in the regions where it is currently the strongest power, the other nations would settle disputes as great and lesser powers have done in the past: sometimes through diplomacy and accommodation but often through confrontation and wars of varying scope, intensity, and destructiveness. One novel aspect of such a multipolar world is that most of these powers would possess nuclear weapons. That could make wars between them less likely, or it could simply make them more catastrophic.Trade-off Spending ScenarioUQ – Budget crisis in military nowBudget cuts have curtailed military forcesRowan Scarborough, 16. 3-27-16. (Scarborough: Staff Writer. “US Military’s Ability to Fight Major Overseas War in Doubt” Washington Times. Accessed 8-1-17. JSD.)“The Marines have a requirement for 38 amphibious ships, but they only have 30 in the fleet,” he said. “And Marine Corps aviation is in crisis. Pilots are not flying. “Each of our military services remains undersized, unready and underfunded to meet current and future threats,” he said. Why the crunch? The overriding factor is the 2011 Budget Control Act that mandated across-the-board cuts and then limited agency spending. Last year’s bipartisan budget agreement provided some relief to the Pentagon — $25 billion. But a congressional aide says it is still $17 billion short for fiscal 2017, which begins Oct. 1. Mr. McCain criticizes President Obama, saying that as commander in chief he should recognize the readiness crisis and ask Congress for more spending. The military needs 52bill. to pursue readiness goals, among othersRuss Read, 6-12-17. (Read: Pentagon/Foreign Policy Reporter. “Mattis on military Spending: ‘The Surest Way to Prevent War is to be Prepared to Win One.” DailyCaller. Accessed 8-1-17. JSD.)And they understood that while there is no way to guarantee peace, the surest way to prevent war is to be prepared to win one,” said Mattis. In order to achieve that goal, Mattis said President Donald Trump has requested a $639.1 billion “topline” for the fiscal year 2018 budget, $64.6 billion of which will go towards Overseas Contingency Operations. The budget request is $52 billion over the cap placed by the National Defense Budget Control Act, passed and signed into law by President Barack Obama in 2011. The Fiscal Year 2018 budget has five priorities: “restoring and improving warfighter readiness, increasing capacity and lethality, reforming how the Department does business, keeping faith with Service members and their families, and supporting Overseas Contingency Operations.” Readiness has been a major priority for the armed forces. Military leaders have warned that each of their respective services are suffering from readiness shortfalls, mostly due to a lack of funding. The Army is low on manpower, the Navy is struggling to maintain ships and aircraft, the Marine Corps is undermanned, under-trained and poorly equipped, and the Air Force is small and aging, the vice Joint Chiefs of Staff warned the committee in February.UQ – So much moneyHealthcare spending is a huge draw on the military budgetMackenzie Eaglen and Morrison, 13. 10-17-13. (Eaglen: resident fellow in the Marilyn Ware Center for Security Studies at the American Enterprise Institute. “Preserving the Military Health Care Benefit: Needed Steps for Reform.” American Enterprise Institute. Accessed 8-1-17. JSD.) Despite the threat of almost $1.5 trillion in cuts to the US military, top-line reductions are only one component of the multitude of challenges facing the Pentagon. The rising cost of personnel within the Department of Defense is squeezing the budget from within as military health care costs, the largest personnel cost driver, grow exponentially. Although the cost of military pay, allowances, and health care has risen 90 percent since fiscal year (FY) 2001, the active-duty personnel count has risen by less than 3 percent.[1] These pay and benefits increases were created with the best of intentions in the midst of two brutal wars, but they have reached the point where they are simply unsustainable. This spending is set to rise further, threatening to crowd out crucial modernization spending and leave the United States behind the cutting edge. In the words of former defense secretary Robert Gates, “Health-care costs are eating the Defense Department alive.”[2] In FY 2013, DoD requested a total of $48.7 billion for military health care—approaching 10 percent of its base budget. Increasingly, this money is going to individuals no longer in the military, while active-duty service members are seeing a decreasing share of DoD health benefits. According to TRICARE’s 2012 annual report to Congress, active-duty members make up only 15 percent of all military health care beneficiaries, while retirees of all ages and their family members make up 53 percent.[3] In less than a decade, defense health care spending increased by over $25 billion, from $17.4 billion in FY 2000 to $42.5 billion in FY 2008, a 144 percent increase.[4] At this rate, health care spending is growing faster than the Defense Department’s discretionary spending. Given demographic trends and spiraling health care costs across the wider US economy, this trend will only grow more pronounced in future years. The Congressional Budget Office (CBO) projects that military health care costs will increase to $65 billion by 2017 and $95 billion by 2030—nearly a 100 percent increase from today.[5]UQ – MHC SucksMilitary healthcare doesn’t meet field needsJustin Johnson, 16. 2-17-16 (Johnson: Senior analyst for defense budgeting policy in the Heritage Foundation’s Center for National Defense. “It’s Time to Improve Military Health Care.” War on the Rocks. Accessed 8-1-17. JSD.)At the same time, the current military health system is not optimized to provide medical support to an active, global military. TRICARE and the military treatment facilities produce doctors who overwhelmingly focus on providing care to military families rather than the types of injuries and health problems seen in combat. While military medical professionals have done amazing work saving lives in Iraq, Afghanistan, and elsewhere, some of this expertise might be fading, in part because the military medical practitioners at home are not focused on trauma. The top two inpatient procedures in military hospitals, both by volume and by cost, are pregnancy/childbirth and newborn care. In fact, in 2014 there were twice as many pregnancy and newborn care procedures in military hospitals as the rest of the top 20 procedures combined. An IDA study of military medical staff concluded that the military “understaffs operationally required specialties” and “overstaffs beneficiary care specialties.” For example, the Army had only 126 general medicine doctors in uniform but needs to be able to deploy 378. At the same time, the Army has 232 pediatricians in uniform, but only needs to be able to deploy one. Caring for military families is vitally important, but pediatricians are not in high demand in combat medicine.Military healthcare mainly serves non-active personnelJohn Kokulis 13. 10-17-13. (Kokulis: Board of Directors for Gold coast Veterans Foundation. “Preserving the Military Health Care Benefit: Needed Steps for Reform.” American Enterprise Institute. Accessed 8-1-17. JSD.) These new benefits not only have increased the DoD’s health care budget, but also have altered the profile of those the military health care system serves. Of the 9.7 million beneficiaries currently eligible for TRICARE, only 15 percent are active duty.[31] Dependents and families of active-duty members represent another 21 percent, and retirees, both under the age of 65 and those Medicare eligible, along with their family members, make up 53 percent of TRICARE-eligible beneficiaries.IL- TradeoffHealthcare spending trades off with defenseMackenzie Eaglen and Morrison, 13. 10-17-13. (Eaglen: resident fellow in the Marilyn Ware Center for Security Studies at the American Enterprise Institute. “Preserving the Military Health Care Benefit: Needed Steps for Reform.” American Enterprise Institute. Accessed 8-1-17. JSD.) For one, as CBO notes, the “growth rates of per-person costs in the military health system over the past six years have been significantly higher than the corresponding national averages.”[6] Much of this cost growth was due to generous TRICARE benefits and relatively low cost sharing. This led many enrollees in TRICARE Prime, for instance, to consume health care at a much higher rate than civilians enrolled in traditional plans. A related issue is how the military health system provides private-sector care for its beneficiaries, especially retirees. From FY 2001 to FY 2006, costs for purchased care increased by 19.6 percent per year, while direct care costs grew by only 6.2 percent annually.[7] These cost increases are not going unnoticed. A consensus has begun to emerge that the rising cost of military health care is unsustainable and poses a challenge as spiraling costs undermine the military’s ability to train, equip, and supply America’s men and women in uniform. As retired Marine Corps General Arnold Punaro has said, “I am very concerned that as current trends continue, this country will not have the strong military it needs 20 years from now, because all of the money is going to go to pay people that are no longer serving.”[8] Punaro is not alone in this concern. In fact, in 2011, the Joint Chiefs of Staff penned a 24-star letter—signed by the chairman, vice chairman, and four service chiefs, in support of modest increases in TRICARE cost-sharing requirements as a first step to getting rising spending under control.[9] The letter insisted that fee increases would not break faith with those in uniform but, rather, were necessary given increasing budgetary pressure—which has only since increased.Healthcare spending detracts from military readinessJohn Kokulis 13. 10-17-13. (Kokulis: Board of Directors for Gold coast Veterans Foundation. “Preserving the Military Health Care Benefit: Needed Steps for Reform.” American Enterprise Institute. Accessed 8-1-17. JSD.) Introduction The rise in military health care spending has been a primary driver of the large growth in military personnel compensation over the past decade. Left unchecked, these costs will impact the ability of the DoD’s Military Health System (MHS) to support its three critical missions: Readiness for deployment: Maintaining an agile, fully deployable medical force and a health care delivery system so they are capable of providing state-of-the-art health services anytime, anywhere; Readiness of the fighting force: Helping commanders create and sustain the most healthy and medically prepared fighting forces anywhere; and The benefits mission: Providing long-term health coaching and health care for 9.7 million DoD beneficiaries.[11] At the center of these three missions are the DoD’s Military Treatment Facilities (MTFs) and the medical professionals that work and train at them. IL – Private inflation of costsHealthcare costs are driven up by private inflationJohn Kokulis 13. 10-17-13. (Kokulis: Board of Directors for Gold coast Veterans Foundation. “Preserving the Military Health Care Benefit: Needed Steps for Reform.” American Enterprise Institute. Accessed 8-1-17. JSD.) Medical Inflation. The second-highest contributor, representing 32 percent of the increase, is medical cost inflation.[32] While part of this growth is due to the same factors increasing costs of all public and private US health plans, the DoD’s health care plan is experiencing additional increases because of its aging population’s tendency to underutilize DoD “direct care.” The military’s TRICARE health system consists of a combination of direct care (military hospitals and clinics) and purchased care (the civilian TRICARE network).[33] Active-duty members have priority at MTFs, followed by active-duty family members enrolled in TRICARE Prime. If an MTF is unavailable or if they choose civilian care, those families and retirees enrolled in Prime can select a civilian TRICARE provider. This increases costs, because as in the purchased care system, the DoD pays in full for every dollar of service provided to a beneficiary at a civilian clinic.Recruitment/Obesity ScenarioIL – Budget and Obesity (this is weird)Obesity increases medical and training costs- directly effects wellness and trades off with other DOD budget prioritiesLisel Loy and Leah Ralph, 7-16-2012, (Bipartisan Policy Center’s vice president of programs and director of its Prevention Initiative) "Department of Defense: An Ally in the War Against Obesity," Bipartisan Policy Center, Department of Defense’s (DoD) interest in keeping Americans healthy goes well beyond the usual public health concerns surrounding obesity and chronic disease. Employing 1.47 million military personnel and an additional one million in the reserves, DoD’s very ability to do its job—defending our nation—hinges on the health and wellbeing of its employees. Yet current health data indicates that the pool of potential recruits is more compromised and less fit than ever before. According to the nonprofit group Mission: Readiness, nearly 27% of 17 to 24 year olds are too overweight to serve. An even more alarming 62% of new soldiers are not immediately deployable because of a significant dental issue, often associated with the consumption of sugary beverages and lack of adequate dental care. Among current personnel, the Navy loses an average of 2,000 trained recruits each year who fail to pass physical fitness tests. At a cost of $100,000 to $200,000 to train each service member, the Navy estimates they lose about $300 million in annual training investments – investments that will have to be made again to train replacements for those who have been discharged. Total health spending at DoD has reached $50 billion annually, or nearly 10% of the overall defense budget, increasingly competing with other defense priorities. The agency has seen its health care costs rise twice as fast as health care costs for the nation as a whole; unhealthy lifestyles, and obesity in particular, are undoubtedly significant contributors to this trend.Obesity increases training and medical costs- basic training isn’t enough PHIT America, 2016, (educational, advocacy campaign focusing on fitness and health in the U.S.) "INCREASING OBESITY & LACK OF PE STANDARDS AFFECTING MILITARY READINESS" - RET. LIEUTENANT GENERAL HERTLING, cited the additional medical expenses required for unprepared and out-of-shape soldiers, injured during basic training, Mission Readinessbecause their bodies are not used to the sudden surge of physical activity that is connected with basic training and getting ready for combat. These injuries are costing the Army roughly $100,000 to $300,000 per soldier to heal. And in some cases, the soldiers have not recovered from the injuries and have had to be dismissed from the Army. “These injuries to soldiers were caused by a lack of daily P.E. in their earlier lives and increasingly inadequate nutrition, which contribute to brittle bones”, stated Hertling. Hertling says obesity and related cardiovascular issues such as type I and II diabetes will reach pandemic proportions by 2030 if something is not done now in terms of the approach to nutrition and daily physical activity.Obesity kills military budgets- trades off with other key programsPHIT America, 2016, (educational, advocacy campaign focusing on fitness and health in the U.S.) "INCREASING OBESITY & LACK OF PE STANDARDS AFFECTING MILITARY READINESS" - RET. LIEUTENANT GENERAL HERTLING, , who is a member of Mission: Readiness, added that the impact of obesity on our economy, if it continues to grow at current levels, will also affect funding for national security, as defense budgets will continue to focus on treating those with diseases, maladies and illnesses associated with obesity. If this obesity epidemic continues, we will soon be spending a significantly larger portion of our DOD budget and our GDP on health care issues.IL – Active SoldiersAffects active soldiers – not just recruitmentAndrew Tilghman, 9-11-16. (Tilghman: Pentagon Bureau Chief, Military Times. Received a lot of journalism awards, B.A of History from Emory and a M.S. in Journalism from Columbia (with honors). “The U.S. Military has Huge Problem with Obesity and It’s Only Getting Worse.” Military Times (Pretty significant source TBH). Retrieved from: 9-27-16. JSD)And maybe, too, the military is simply reflecting the nation's broader population, whose poor eating habits are fueling an alarming rise obesity rates. This much is clear, though: Today’s military is fatter than ever. For the first time in years, the Pentagon has disclosed data indicating the number of troops its deems overweight, raising big questions about the health, fitness and readiness of today's force. About 7.8 percent of the military — roughly one in every 13 troops — is clinically overweight, defined by a body mass-index greater than 25. This rate has crept upward since 2001, when it was just 1.6 percent, or one in 60, according to Defense Department data obtained by Military Times. And it's highest among women, blacks, Hispanics and older service members. Compared to the U.S. civilian population, the rate of overweight troops is far smaller. About 70 percent of the adult American population is clinically overweight or obese, according to data from the U.S. Centers for Disease Control. Defense Department health officials released the data after multiple requests from the Military Times. They did not provide service-specific data to show the rate of overweight troops specifically within the Army, Navy, Air Force and Marine Corps. This disclosure comes at a time when top Pentagon health officials are rewriting forcewide guidelines for body composition standards and the methods for officially evaluating it. For individual troops, a diagnosis of obesity can stall a career or lead to involuntary separation, so these policies are central to military life. Some Pentagon officials say the mounting signs of obesity are nothing to worry about. Yet others say obesity can be a life-and-death issue on the battlefield. Overweight troops may not move as quickly in ground combat, making them easier targets. And if they are wounded, it is more difficult for their buddies to pull them to safety. “If I have to climb up to the top of a mountain in Nuristan, in Afghanistan, and if I have someone who is classified as clinically obese, they are potentially going to be a liability for me on that patrol,” said Army Command Sgt. Maj. John Troxell, the military’s top noncommissioned officer and the senior enlisted adviser to Joint Chiefs Chairman Gen. Joseph Dunford.IL – Obesity and MRObesity epidemic kills military readinessRoxana Hegeman, 7/15/15, Report: Nearly 1 in 3 young adults too fat for military, Military Times, nation's obesity epidemic is causing significant recruiting problems for the military, with one in three young adults nationwide too fat to enlist, according to report issued Wednesday by a group of retired military leaders. The nonprofit, non-partisan group called Mission: Readiness (Military Leaders for Kids) is promoting healthy school lunches in Kansas and across the nation as a way to combat the problem. In Kansas, 29 percent of teenagers are overweight, according to figures it cites from the Centers for Disease Control and Prevention. About a third of American children and teens are considered obese or overweight. "We think a more healthy lifestyle over the long term will have significant impacts on both the military posture — those available to get into the military — and across our society as a whole from a medical perspective," retired Brig. Gen. John Schmader said in a phone interview ahead of the report's release. Obesity is among the leading causes of military ineligibility among people ages 17 to 24, the report notes. Others are a lack of adequate education, a criminal history or drug use. All those put together mean that 71 percent of Kansans are ineligible for military service, according to the group. The military has also seen a 61 percent rise in obesity since 2002 among its active duty forces, driving up obesity-related health care spending and costs to replace unfit military personnel, the report said.Even a 1% reduction in obesity solves military recruitment and readinessLori M. Hunter, September 2013, (associate professor of sociology, Institute of Behavioral Science, Programs on Population, Environment and Society, at the University of Colorado) Obesity Epidemic a Threat to U.S. Military Personnel and National Security, Population Reference Bureau, obesity epidemic in the United States affects public health and the labor market, but researchers suggest that obesity may also affect national security. Mission: Readiness, an organization of retired military leaders, has reported that 27 percent of today’s young adults are too fat to serve in the military, causing concern about the strength of the nation’s future military.1 The U.S. Department of Defense must recruit nearly 190,000 new military personnel every year to replace those retiring or leaving military service for other reasons. Nearly one-quarter of all applicants to the military are medically disqualified because of excessive weight and body fat. Disqualification due to obesity ranks far higher than the second-top reason: smoking marijuana (nearly 13 percent of disqualifications).2 Cornell Population Center researchers John Cawley and Johanna Catherine MacLean used data from the National Center for Health Statistics to estimate current military ineligibility and project obesity’s future impact on military readiness. In 2007-2008, nearly 12 percent of eligible male civilians (ages 17 to 42) and 35 percent of eligible women exceeded the Army’s weight and body fat limits. These levels reflect substantial increases over the past four decades. From 1959 to 2008, the percentage of men who were ineligible for enlistment because of their weight doubled, while the percentage of ineligible women tripled.2 As to the future, Cawley and MacLean reported that a gain of just 1 percent body fat would disqualify more than 850,000 additional men and 1.3 million women from Army service. And military leaders emphasize that today’s high levels of obesity among children present challenges in recruiting tomorrow’s military.Obesity - POCObesity is the number one health threat that disproportionately hurts low income households and people of color.Bipartisan Policy Center, June, 2012, Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future, several measures, obesity is already the single largest threat to public health in America today. According to the American Cancer Society, obesity is now responsible for roughly as many cases of cancer as smoking.3 It also affects a far larger number of people; as we noted in the introduction, well over half the U.S. population – twothirds of adults and one-third of children and adolescents – is obese or overweight. Obesity is not only extremely prevalent, it has alarming consequences for people’s health. A 2001 study found that obese people had a 67 percent higher chance of suffering from conditions like diabetes, hypertension, asthma, heart disease and cancer than normal-weight people of the same age and social demographic.4 Obese people also spent much more on medical services – 36 percent more, on average, than normal-weight individuals. In sum, obesity is a major reason why nearly half the U.S. population today – about 145 million people in total – suffers from one or more chronic diseases.5 These impacts are borne by all segments of society, but they disproportionately affect lowincome households and communities of color.6 And the resulting health care costs affect us all.Obesity is a public health crisis that disproportionately affects people of color. Y Wang and MA Beydoun, 2009, (MD, Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health) Meat consumption is associated with obesity and central obesity among US adults Int J Obes (Lond). 2009 Jun; 33(6): 621–628., increases the risks of a number of other chronics diseases, such as cardiovascular disease, hypertension, diabetes, dyslipidemia and certain types of cancer.1?Obesity has become a global epidemic,1,2and is becoming a public health crisis in the United States.3,4?National survey data show that the prevalence of obesity and overweight has doubled since the 1970s, with minority and low-socioeconomic status (SES) groups being disproportionately affected.4,5?Despite this rising trend, the primary causes for the epidemic and the disparities between population groups are still a matter of debate.SolvencyHR676 covers obesity programsHR676 (HR676: the literal bill in question. “HR676: To provide for comprehensive health insurance coverage for all United States Residents, improved health care delivery, and for other purposes.” Authenticated US Government Information. 8-2-17 . JSD.)IN GENERAL.—The health care benefits under 12 this Act cover all medically necessary services, including at least the following: 14 (1) Primary care and prevention. 15 (2) Approved dietary and nutritional therapies. 16 (3) Inpatient care. 17 (4) Outpatient care. 18 (5) Emergency care. 19 (6) Prescription drugs. 20 (7) Durable medical equipment. 21 (8) Long-term care. 22 (9) Palliative care. 23 (10) Mental health services. 1 (11) The full scope of dental services, services, 2 including periodontics, oral surgery, and 3 endodontics, but not including cosmetic dentistry. 4 (12) Substance abuse treatment services. 5 (13) Chiropractic services, not including elec- 6 trical stimulation. 7 (14) Basic vision care and vision correction 8 (other than laser vision correction for cosmetic pur- 9 poses). 10 (15) Hearing services, including coverage of 11 hearing aids. 12 (16) Podiatric care.Medicare covers both preventative and direct treatment for obesityMedicare Initiative n.d. (“Medicare Coverage of Obesity Screenings and Behavioral Therapy” Medicare Initiative. Accessed 8-2-17. JSD.)Medicare covers body mass index (BMI) screenings and behavioral counseling for all people with Medicare who are obese. Medicare will only cover the screening and counseling sessions if you receive them in your doctor’s office or other primary care setting. Persons are obese if they have a Body Mass Index (BMI) of 30 or more. Once your primary care doctor or other health care provider concludes that you are obese, you can qualify for behavioral counseling and therapy. This counseling is intended help you lose weight and sustain your loss through proper diet and exercise. You are entitled to a series of visits. Medicare will coverWeight-Loss coverage is effective – empirics proveSara Bleich and Herring, 12. 9-6-12. (Bleich: PhD, Dept. of Health Policy and Management at Bloomberg School of public Health [Johns Hopkins]. Herring: ditto. “Medicare coverage for Weight Loss Counseling May make ‘Cents’” NCBI, NIH. Accessed 8-2-17. JSD.)In this issue of JGIM, the article by Mitchell et al.5 suggests that coverage of weight-loss counseling programs may be a good investment for Medicaid. Weight Watchers, which was the focus of this article, runs approximately 20,000 meetings a week around the country and offers online food tracking tools that are designed to easily help people navigate the food environment. Mitchell et al. found that enrollees in Tennessee’s TennCare Medicaid program who joined Weight Watchers typically lost about 1.9 kg (4.2 lb) after seven sessions and that participants who attended more meetings lost more weight. The authors also conducted sensitivity analyses including enrollees who attended the initial session but subsequently withdrew from the program and made the conservative assumption that those individuals lost no weight. This still yielded a 1.1-kg (2.4-lb) weight loss from the intervention. The cost to Medicaid was nominal: $19 for an introductory session and $11 for each follow-up session with Medicaid enrollees contributing $1 per session. These findings by Mitchell et al. are consistent with other research on behavioral weight-loss programs, which observed an average weight loss of 4 to 7 kg (8.8 to 15.4 lb) after 12 to 26 sessions.6 These programs are also associated with a decrease in the incidence of weight-related comorbidities such as type 2 diabetes7 and have been shown to be as cost-effective as bariatric surgery and more cost-effective than drug therapy.8 A simple “back of the envelope” calculation using Mitchell et al.’s findings helps illustrate this intuition: TennCare’s Weight Watchers program costs an average of $85 ($19 for the initial session and $11 for each subsequent session) for a (conservative) weight loss of 2.4 lb, yielding a net cost of $35 per pound ($85/2.4 lb). Alternatively, a 243-lb person (i.e., the median weight for an obese person in their TennCare sample) who receives bariatric surgery and loses the typical 60 % of his/her weight would cost about $12,500 for a weight loss of 146 lb, yielding a higher net cost of $86 per pound ($12,500/146 lb). This $12,500 estimate is based on the Medicare fee schedule for an individual getting an OR procedure with a co-morbidity and converted to an estimated Medicaid payment using average Medicaid/Medicare charge ratios. For private insurers looking to adopt this benefit, the cost per pound would be considerably higher as Medicaid pays about a third less than private insurers.Diplomacy ScenarioHeg Neg**Recruitment turn: People join the military because they want healthcare, plan takes away that incentiveObesity AnsObesity scenarioReversing obesity will take decades.Denton Record-Chronicle, 16 5/23/16, "Obesity may impact national security," , obesity has become deeply embedded in American society. It will take years, maybe even decades, to reverse the trend toward plus sizes. In the 1960s, we began learning the truth about smoking and its health effects. Fewer people smoke today. So, there is hope.Obesity doesn’t hurt military readiness. Andrew Tilghman, 16 9-12-2016, "Military data reveals obesity issue, and it's getting worse," USA TODAY, said today’s force is combat ready, but he believes the obesity trends are troubling and demand careful consideration from senior leaders. “I don’t think it’s a clear readiness concern right now. But I think it’s something that needs our attention. And we really have to look across our services at what we’re doing every morning or every day to prepare the men and women for what could be the worst day of their life,” Troxell said in a recent interview. Top Pentagon health officials say the obesity increase is nothing to worry about. Dr. Terry Adirim, the deputy assistant secretary of defense for health services policy and oversight, suggested there may, in fact, be no real increase in obesity. She called it a “quote-unquote increase” and said the data may just reflect the fact military doctors are more aware of obesity and for that reason flagging it more often in official health records. “A physician who is now more aware about nutrition and fitness, they may be diagnosing it more than previous years. ... You can’t tell from these numbers exactly what it is that is accounting for these apparent increases,” Adirim said.SolvencyMedicare doesn’t fully cover obesity treatmentsJennifer Carey, 14. 9-19-14 (Carey: Director of federal government relations and alliances development. “Why Won’t Medicare Cover Effective Obesity Drugs?.” The Hill. Accessed 8-2-17. healthcare JSD.)Unfortunately, patients relying on Medicare Part D don’t receive the same benefits as most federal employees and those with private insurance. Medicare Part D still prohibits coverage of FDA-approved obesity drugs, reasoning that these medications are subject to an exclusion from Medicare coverage for medicines used to treat anorexia, weight loss or weight gain. This inappropriate ban on coverage of obesity medications creates an unreasonable barrier for patient access to these important medicines, and is a disincentive for continued investment in obesity medicines-related R&D.Heg turnsRecruitment TurnThere have always been people joining the military for the benefitsBollinger 6/12/17 (Alex Bollinger is a former managing editor of The Bilerico Project. He holds a Masters degree from the Paris School of Economics and lives in Paris with his partner.) LGBTQ Nation. “Republican bizarrely compares trans people to mythical castrated slaves”_8.2.17_WJBSpeaking about the Ottoman Empire, which occupied Turkey and parts of surrounding areas from the thirteenth to twentieth centuries, King said, “What they did in order to keep them from reproducing was that they did reassignment surgery on those slaves they had captured, that they had put into their janissary troops.” The janissaries were an elite corps in the Ottoman military who, among other things, were forbidden from marrying, passing wealth on to their children, or growing beards. By the mid-nineteenth century, they were permitted to marry and have children. And the janissaries were not castrated. This is just a common modern myth. King went on. “And that reassignment surgery was they took them from being a virile, reproductive male into being a eunuch. That’s a lesson of the military — the Ottoman military — from two, three, 400 years ago.” Besides being false, his comments make no sense in their own terms. The janissaries were elite soldiers, feared in Europe for centuries. If he thinks that they had “reassignment surgery,” then… doesn’t his story prove that “reassignment surgery” is good for military readiness? Moreover, by equating forcible castration to sex reassignment surgery, King shows once again that Republicans don’t understand the concept of consent. Performing any surgery on someone who doesn’t want it or need it is terrible, but that doesn’t mean that surgery itself is terrible. King went on to say that transgender people will join the military just to get free health care. “And today, we’re here thinking somehow we’re going to make the military better by letting people line up at their recruitment center who have planned that they want to do sexual reassignment surgery, know that it’s expensive, and believe ‘if I can just get into any branch of the United States services — to the Army, the Navy, the Air Force, the Marines; maybe become a Navy SEAL — and then submit to sexual reassignment surgery and then go from a man to a woman.'” As if no one has ever joined the military for benefits like health care, a salary, housing, or citizenship. Even the military’s own recruitment website touts pay and benefits. If he is actually worried that people will join the military just to get health care, then he should be trying to make health care better for civilians. It goes without saying that he’s doing the opposite. US Military boasts benefits as a primary reason to join the serviceMilitary Infusion ‘14 (Blog about military curiosities in the recruitment process.My mission is to help people leverage the power of information. My goal is to create a learning platform where you can gain insightful and relevant content to better equip you in your decision weather to join or not to join the United States military.) Military Infusion LLC_ _8.2.17_WJBThere are many reasons people join the military and one of those reasons is the great benefits. The military has the best benefit packages in the world. There aren’t too many companies that can match it either. Here are five extrinsic rewards for joining. Money The money is absolutely dependable. During the down economy a steady pay check is something that a lot of Americans are looking to obtain. You can count on Uncle Sam to pay the troops. The entry level pay is outstanding. It doesn’t matter what branch of the military you join. The base pay is the same across all services. Not to mention you will receive food and rent money if authorized. Education When we talk about education benefits there are two types of benefits. The first benefit is Post 9/11 GI Bill. You will pay into this program. It is a small amount in relation to what you will receive. I took it and my son took it. The second benefit is called tuition assistance aka TA. TA is a program that helps pay for college while you are serving. It will pay or offset the cost of college courses. Medical Coverage This benefit is awesome. Image this as a commercial. Military we have you covered. No annual premiums, no deductibles, and no copays. How about that for insurance? Dental Coverage Dental coverage is just like medical benefits. No annual premiums, no deductibles, and no copay. How awesome it that for dental coverage? Trust me dental insurance is one of the most expensive insurances and you are getting it free. Vacation Active duty service members receive 30 days of paid vacations a year. Everyone in the military receives the same number of vacation days a year. It doesn’t matter what your rank. Extra one – Sick leave As a military service member you get unlimited sick days and you still get paid. I promise you no one can beat this one. These benefits without a doubt are some of the world’s best. Many people join for just that reason. If you visit any of the military service’s website you will see they heavily leverage these benefits for recruiting.Changing benefits, namely healthcare, strongly influences recruitment. Unconditional HC coverage is a big reason why people join.Joyner ’13 (James Joyner is the publisher of?Outside the Beltway, an associate professor of security studies at the?Marine Corps Command and Staff College, and a nonresident senior fellow at the?Atlantic Council. He's a former Army officer and Desert Storm vet. He earned a PhD in political science from The University of Alabama. Views expressed here are his own.?) published: Nov 18th, 2013. Navy Admiral John C. Harvey, Jr. recently criticized the popular discourse on military compensation for under-valuing the sacrifices made by our soldiers. Harvey is quite right that “we’re not just debating about pay and allowances or commissary benefits or TRICARE fees. We are talking about the future of our All-Volunteer Force, how we will sustain it, and how it will be able to attract the kind of men and women who will repeatedly deploy into harm’s way.” But that cuts both ways. While the sacrifices borne by those who serve are priceless, pay, allowances, benefits, training, and equipment are not. And, like it or not, the exploding health care and retirement benefits costs for the troopers of today and yesterday are going to make it harder to train, equip, and pay the troopers of tomorrow. Personnel and overhead costs already account for nearly half the defense budget and Army Chief of Staff Ray Odierno forecasts that 80 percent will go to compensation by 2023 unless we fix the problem. Harvey is right to fear taking away benefits that incentivize people to join and make careers of the military. But it absolutely makes sense to explore more cost-effective ways of achieving those goals. So, for example, military base pay exploded during the last dozen years when two shooting wars made recruiting volunteers more difficult. But these increases impact not only the present, but also reverberate into the future through the retirement system. It may be that lump sum enlistment and retention bonuses would do the job at a fraction of the lifetime cost. We should almost certainly increase massively the bonus paid to those actually deployed downrange into hostile fire zones, now a paltry $225 a month, rather than pay everyone more simply for taking a theoretical risk. And, yes, we might even need to consider asking people who retire from the military at the beginning of middle age to start a second career to pay a little more for their health benefits. We’re spending $20 billion a year on pensions for military retirees. To be sure, those who served under the promise of this benefit must be paid. But continuing to offer generous lifeline benefits to young people (as early as 38 years for enlisted personnel and 42 for officers) after twenty years of service is an expensive way to keep our best personnel. The system was put in place in an era when military pay was very low; paying half their small base pay for life was both a necessary enticement to a career of service and relatively affordable. For decades now, our troops have been compensated at a very competitive level and still earn a pension plan found nowhere in the private sector. Harvey concludes by warning us that “Choices have consequences.” Indeed they do. Continuing down an unsustainable course out of fear of making hard choices will have the consequence of a force less prepared to fight America’s next war. In between those excerpts are several paragraphs of detailed analysis. It’s an important debate and, sadly, one the Defense Department has recently punted on. But, as the great philosopher Geddy Lee told us years ago, if you choose not to decide,you still have made a choice.Advantage CPSolvencyThe MCRMC measures save money and solves for military healthcareJustin Johnson, 16. 2-17-16 (Johnson: Senior analyst for defense budgeting policy in the Heritage Foundation’s Center for National Defense. “It’s Time to Improve Military Health Care.” War on the Rocks. Accessed 8-1-17. JSD.)The good news is that there are better options. The MCRMC outlined a proposal that would both provide better health care to servicemembers and their families and enable the military to focus its medical professionals on skills most needed in combat. First, the commission proposed that DOD identify Essential Medical Capabilities (EMCs). According to the commission, EMCs include skills such as “clinical and logistical capabilities related to combat casualty care; medical response to and treatment of injuries sustained from chemical, biological, radiological, nuclear and explosives incidents; diagnosis and treatment of infectious diseases; aerospace medicine; and undersea medicine.” Once these critical capabilities are identified, DOD can design its medical system to ensure that military has sufficient numbers of medical providers that are proficient in these key areas. In addition to redesigning the military’s medical system around EMCs, the MCRMC proposed moving military dependents to a health insurance model similar to what government civilians use today. If done properly, this would provide better coverage options and care for servicemembers and their families. Servicemembers would still get their healthcare through the military system directly, but family members and retirees would enjoy greater access to non-military providers while still retaining the option of using military treatment facilities. This change would also allow more flexibility for the military medical system to be refocused on EMCs without disrupting care for military families. Additionally, the MCRMC believes this proposal would be cost-neutral for military families and actually save the military money over time.HegMilitary Treatment facilities cut costs and ensure military readinessJohn Kokulis 13. 10-17-13. (Kokulis: Board of Directors for Gold coast Veterans Foundation. “Preserving the Military Health Care Benefit: Needed Steps for Reform.” American Enterprise Institute. Accessed 8-1-17. JSD.) This increases costs, because as in the purchased care system, the DoD pays in full for every dollar of service provided to a beneficiary at a civilian clinic. If the beneficiary were to visit an MTF, however, the only cash out of pocket for the DoD would be for any variable expense from the visit, such as medicine and supplies. These kinds of variable expenses usually constitute only 10-40 percent of the visit’s expenses. All other costs, such as doctors and facilities, are fixed and have already been paid for from the DoD budget, whether the facility is fully used or not. A $1,000 trip to a doctor in the purchased care system would cost the DoD a full $1,000, but that same visit to an MTF would run only anywhere from $100 to $400. Until they reach capacity, the MTFs are a lower-cost alternative to paying expenses in full to the purchased care network. More importantly, from a readiness perspective, with so many retirees now getting their care in the purchased care system—because of either convenience or lack of appointment availability at the MTFs—not only do costs go up, but the effectiveness of the MTF and those that train there is also eroded. MTFs need these “case intensive” retirees to provide the proper training to their medical staff. Of course, the kind of care retirees require does not exactly mirror the kind of care required on the battlefield. That said, many procedures common among an aging population, such as open-heart surgery, hip replacements, and chronic disease contribute a necessary—if perhaps not sufficient—role in keeping medical staff in shape and ready. This is an important issue and one that I address in the Recommendations section of this report.Pharma Turns HegNew drugs solve obesityThe DA turns heg – Pharma innovation key to successful obesity-targeting drugsSurbhi Gupta, 6-27-17. (Gupta: M. Pharm., Business Insights Analyst. “Emerging interest of Big Pharma in Obesity: Will the Market for Prescription Antiobesity Drugs see new light?” DRG. Accessed 8-2-17. JSD.)Eisai’s Belviq, Vivus’s Qsymia, Orexigen’s Contrave, and Novo Nordisk’s Saxenda were launched in the United States during 2012-2016. In Europe, Saxenda and Mysimba (Contrave) successfully reached the market. However, the available drugs elicit modest weight-loss and are associated with safety issues. Worse still, the late-stage pipeline for obesity remains sparse, with only one drug in Phase III, ’s combination of canagliflozin and phentermine. Novo Nordisk - the “trailblazer” in obesity Despite high unmet need and huge patient number to be treated, most of the major pharmaceutical companies refrained from investing in R&D for antiobesity drugs. However, Novo Nordisk followed a different path and launched Saxenda in all the major markets (U.S. launch in 2015, European launch in 2016) except France and Japan. Saxenda is the higher dose of glucagon-like peptide-1 (GLP-1) receptor agonist, liraglutide, which was first launched for type 2 diabetes as Victoza. The company in its 2016 annual report stated that Saxenda has captured 35% of the value market share in the United States. The company plans to establish its leadership in obesity and is making significant investment in R&D for antiobesity drugs. The company has a strong presence in the early-stage pipeline for obesity, with seven novel compounds, all with different mechanisms of actions (Refer to the table below for the list of Novo Nordisk’s early-stage molecules for obesity). “Dual game” of obesity and type 2 diabetes Owing to a negative reputation created by high profile withdrawals of centrally acting drugs, big pharmaceutical companies have considered the development of antiobesity drugs as prohibitively risky. With the development of peripherally acting molecules from the antidiabetic drug classes, pharmaceutical companies aim to specifically avoid the CNS effects that led to the withdrawals of antiobesity drugs. Further, Saxenda’s launch motivated Big Pharmas including Johnson & Johnson, AstraZeneca, Novartis, and Sanofi to adopt Novo Nordisk’s low-risk strategy of diversifying the diabetes portfolio to obesity. Interestingly, all of these major pharmaceutical companies have an established portfolio in type 2 diabetes. These companies are aiming to capitalize on the strong association between type 2 diabetes and obesity. Moreover, these companies already have a large sales force targeted toward endocrinologists for selling antidiabetic drugs. Therefore, if successful, these companies do not need to make extra investments to sell their potential antiobesity drugs. Johnson & Johnson’s “low-risk” path Johnson & Johnson is following a low-risk pathway to enter the market for prescription antiobesity drugs, without making any investment in the development of a novel molecule. The company’s prudent move of development of canagliflozin and phentermine combination is a blend of Novo Nordisk’s and Vivus’s strategies for Saxenda and Qsymia, respectively. The company followed Novo Nordisk’s approach of indication expansion of its antidiabetic drug, and Vivus’s tactic of combining the most used generic antiobesity drug, phentermine, with another marketed drug. Future perspective The years before 2012 witnessed a dry period for the approvals of antiobesity drugs, with the FDA pushing back several potential antiobesity drugs. However, post-2012, the FDA became more receptive to antiobesity drug approvals. These FDA approvals may be giving pharmaceutical companies positive signals to venture into the antiobesity drugs market. With the increasing investments by large pharmaceutical companies in obesity, it is increasingly likely that the unmet need for an antiobesity drug that elicits sustained weight loss, and is safe and well-tolerated will be fulfilled. We anticipate that there is a strong likelihood that Johnson & Johnson’s combination of canagliflozin and phentermine, and Novo Nordisk’s semaglutide will launch before 2025. These expected launches have the potential to expand the market for prescription antiobesity drugs.Pharma is currently testing anti-obesity drugs – the plan disincentives that . See inserted chart.Surbhi Gupta, 6-27-17. (Gupta: M. Pharm., Business Insights Analyst. “Emerging interest of Big Pharma in Obesity:Will the Market for Prescription Antiobesity Drugs see new light?” DRG. Accessed 8-2-17. JSD.)Major pharmaceutical CompanyMolecule in pipelinePhase of developmentMechanism of actionIs the molecule currently under development for type 2 diabetes?Novo NordiskSemaglutidePhase IIGlucagon-like peptide 1 (GLP-1) receptor agonistYesTri-agonist 1706/NN9423Phase ITriple agonist of GLP-1, gastric inhibitory peptide (GIP) and glucagon (GCG) receptorsNoAM833/NN9838Phase IAmylin analogueNoG530S/NN9030Phase IGlucagon analogueNoFGF21 Obesity/NN9499Phase IFibroblast growth factor 21 analogueNoGG-co-agonist 1177/NN9277Phase IDual agonist of GLP-1 and GCG receptorsNoPYY 1562/NN9747Phase IPeptide YY hormone analogueYesJohnson & JohnsonHM12525A/JNJ-64565111Phase IDual agonist of GLP-1 and GCG receptorsYesNovartisLIK066Phase IISodium?glucosetransport 1 and 2 inhibitor (SGLT-1/2 inhibitor)YesAstraZenecaMEDI0382Phase IIDual agonist of GLP-1 and GCG receptorsYesSanofiEfpeglenatide/HM-11260CPhase IIGLP-1 receptor agonistYesABR Turn AffNegLinkMedicare causes an increase in antibiotic useGenevra Pittman, 10. 8-10-10 (Pittman: Medical Journalist and Senior Editor. “More Seniors on medicare Use Antibiotics: Study” Reuters. Accessed 8-2-17 JSD.)NEW YORK (Reuters Health) - More seniors used antibiotics after enrolling in Medicare Part D, the program that helps pay for prescription drugs, in a new study of about 35,000 people. The results are promising for conditions like pneumonia, which is sometimes deadly in the elderly but can be effectively treated with antibiotics, the authors say. But study participants with viruses also took more antibiotics - which don't do anything against those types of infections. Unnecessary use of antibiotics contributes to resistance - when bacteria build up immunity to these drugs and the drugs are no longer effective. "Antibiotics are a unique class of medications; overuse can harm entire populations of patients ... whereas underuse may result in serious complications of infections," wrote Dr. Adam Hersh and Dr. Ralph Gonzales of the University of California, San Francisco, in a commentary on the article, which is published in Archives of Internal Medicine.Medicare makes ABR more likelyRoni Caryn Rabin, 10. 8-16-10. (Rabin: Journalist. “Patterns: Medicare Coverage Drives Antibiotic Use.” New York Times. Accessed 8-2-17. JSD.)That may not sound surprising. But the authors of the study say it could be worrisome. Among the drugs being taken more often, the researchers pointed out, are new broad-spectrum antibiotics that are more expensive and more likely to lead to bacterial resistance than older versions. The study, based on insurance claims from 35,102 older adults, compared oral antibiotic use two years before and after the Medicare Part D drug benefit took effect in 2006. While 28 percent of pneumonia patients without drug coverage filled prescriptions for antibiotics two years before Medicare added the drug benefit, 46.8 percent filled antibiotic prescriptions two years later, the study found. Antibiotic prescriptions also increased for patients with acute respiratory infections, to 59.5 percent from 45 percent. "That is a little bit concerning," said Yuting Zhang, a professor of health policy and management at the University of Pittsburgh who was the lead author of the study, published Aug. 9 in The Archives of Internal Medicine. For acute respiratory infections, Dr. Zhang continued, "an antibiotic may not be necessary and is generally not indicated." Doctors overprescribe antibioticsCDC, 16. 5-3-16. (“CDC: 1 in 3 Antibiotic Prescription Unnecessary.” Center for Disease Control and Prevention – US Dept. of Health and Human Services. Accessed 8-2-7. JSD.)At least 30 percent of antibiotics prescribed in the United States are unnecessary, according to new data published today in the Journal of the American Medical Association (JAMA) by the Centers for Disease Control and Prevention (CDC), in collaboration with Pew Charitable Trusts and other public health and medical experts. The study analyzed antibiotic use in doctors’ offices and emergency departments throughout the United States. CDC researchers found that most of these unnecessary antibiotics are prescribed for respiratory conditions caused by viruses – including common colds, viral sore throats, bronchitis, and sinus and ear infections – which do not respond to antibiotics. These 47 million excess prescriptions each year put patients at needless risk for allergic reactions or the sometimes deadly diarrhea, Clostridium difficile. The researchers also estimated the rate of inappropriate antibiotic use in adults and children by age and diagnosis. These data will help inform efforts to improve antibiotic prescribing over the next five years. “Antibiotics are lifesaving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections,” said CDC Director Tom Frieden, M.D., M.P.H. “Losing these antibiotics would undermine our ability to treat patients with deadly infections, cancer, provide organ transplants, and save victims of burns and trauma.”They’re literally handing them out like candyABC News, 16. 5-4-16. (“New Study Claims Doctors Overprescribe Antibiotics” ABC News. Accessed 8-2-17 JSD.(The study, published in the Journal of the American Medical Association, analyzed antibiotic prescribing in 2010 and 2011 and found there was an antibiotic prescribed in 154 million doctor visits. “But 30 percent of those prescriptions were for conditions where antibiotics don’t work or only work sometimes and the main ones were sinus infections, ear infections, throat infections and bronchitis,” Besser told “GMA” co-anchor Robin Roberts. “The big concern is we’re seeing this big rise in antibiotic-resistant infections, so when you take an antibiotic when it’s not giving you any benefit, you risk that the next time you take that antibiotic, it’s not going to work for you,” he added. “Plus, you’re at risk for the side effects of antibiotics: rashes, diarrhea and, for women, yeast infections.” Instead of asking for an antibiotic, Besser advised, ask yourself, “What can I do to feel better faster?” “[There’s] studies that show that -- ‘Did you ask for an antibiotic?’ -- doctors [are] more likely to give it to you, even if it’s not indicated. And believe me, doctors will prescribe one if it’s indicated,” Besser said. “But, they feel they want you to be happy and so they’re going to prescribe that antibiotic sometimes where it’s not indicated.”Medications are the key contributor to ABRC. Ventola, 15. 4-15. (Ventola: Consultant Medical Writer. ”The Antibiotic Resistance Crisis: Part one – Causes and Threats” Pharmacy and Therapeutics (A peer reviewed journal for managed care and hospital formulary management). . Accessed 8-2-17. JSD.)The rapid emergence of resistant bacteria is occurring worldwide, endangering the efficacy of antibiotics, which have transformed medicine and saved millions of lives.1–6 Many decades after the first patients were treated with antibiotics, bacterial infections have again become a threat.7 The antibiotic resistance crisis has been attributed to the overuse and misuse of these medications, as well as a lack of new drug development by the pharmaceutical industry due to reduced economic incentives and challenging regulatory requirements.2–5,8–15 The Centers for Disease Control and Prevention (CDC) has classified a number of bacteria as presenting urgent, serious, and concerning threats, many of which are already responsible for placing a substantial clinical and financial burden on the U.S. health care system, patients, and their families.1,5,11,16 Coordinated efforts to implement new policies, renew research efforts, and pursue steps to manage the crisis are greatly neededAntibiotics are too accessible to be controlledC. Ventola, 15. 4-15. (Ventola: Consultant Medical Writer. ”The Antibiotic Resistance Crisis: Part one – Causes and Threats” Pharmacy and Therapeutics (A peer reviewed journal for managed care and hospital formulary management). . Accessed 8-2-17. JSD.)In the U.S., the sheer number of antibiotics prescribed indicates that a lot of work must be done to reduce the use of these medications.12 An analysis of the IMS Health Midas database, which estimates antibiotic consumption based on the volume of antibiotics sold in retail and hospital pharmacies, indicated that in 2010, 22.0 standard units (a unit equaling one dose, i.e., one pill, capsule, or ampoule) of antibiotics were prescribed per person in the U.S.17 The number of antibiotic prescriptions varies by state, with the most written in states running from the Great Lakes down to the Gulf Coast, whereas the West Coast has the lowest use (Figure 2).5,12 In some states, the number of prescribed courses of treatment with antibiotics per year exceed the population, amounting to more than one treatment per person per year.12 In many other countries, antibiotics are unregulated and available over the counter without a prescription.10,15 This lack of regulation results in antibiotics that are easily accessible, plentiful, and cheap, which promotes overuse.15 The ability to purchase such products online has also made them accessible in countries where antibiotics are regulated.15ImpxAntibiotic resistance causes extinction- outweighs nuclear warJulian Urrutia, 2-7-2014, "The bright side of antibiotic resistance," Petrie-Flom Center at Harvard Law School, parent’s generation grew up in fear of a nuclear apocalypse: the cold war was raging, team USA and team USSR were competing in a frightening arms race, and people were building bomb shelters in preparation for a nuclear end to the world. That’s like so 1950’s though; what’s hot now is the environmental apocalypse. We all know about rising water levels, and some doomsayers are even warning that enough methane is about to be released from the icecaps to cause the greatest mass extinction since the dinosaurs. Me? I’m not too concerned about either of these scenarios, but it’s not because I’m much of an optimist. It’s because I’m convinced that bugs will kill most of us before we kill ourselves. In 1928, Alexander Fleming discovered penicillin, and it was being mass produced by World War II. This means it has effectively been around for at least 70 years, and it still works against a broad range of bacteria. Superb; 70 years is a hefty amount of time–enough for billions of doses to have been administered–and we’re still going strong. But bacteria don’t care. They’re (still) here, they’re (always) evolving, get used to it. I say that because I don’t believe we’re going to be able to keep discovering new classes of antibiotics ad infinitum–although I certainly hope I’m wrong. But if I’m not, it means that we’re only ever going to have so many treatment options, and that the bugs are eventually going to become resistant to all of them (although probably not in our lifetime).Antibiotic resistance will kill 10 million people per year and wreck the economyMaryn Mckenna, 12-15-2014, "The Coming Cost of Superbugs: 10 Million Deaths Per Year," WIRED, YOU WEREN’T taking antibiotic resistance seriously before, now would be a good time to start. A project commissioned by the British government has released estimates of the near-future global toll of antibiotic resistance that are jaw-dropping in their seriousness and scale: 10 millions deaths per year, more than cancer, and at least $100 trillion in sacrificed gross national product. The project, called the Review on Antimicrobial Resistance, was commissioned by UK Prime Minister David Cameron last summer, a follow-on to the dire report issued in 2013 by the UK’s Chief Medical Officer, which ranked resistance as serious a threat to society as terrorism. To chair the effort, Cameron recruited Jim O’Neill, previously the head of economic research for Goldman Sachs (and the person credited with coining the acronym BRICs — Brazil, Russia, India, China — as part of forecasting that global economic power would shift south and east). The Review is envisioned as a two-year project that will publish periodically, ending in July 2016 with recommendations for actions to blunt the threat that antibiotic resistance poses worldwide. (The project is supported by the nonprofit Wellcome Trust.) Their first paper, released late last week, is based on work by two consulting teams, from RAND and KPMG, examining just the effect of resistance in six pathogens: three commonly resistant bacterial infections, Klebsiella pneumoniae, E. coli and MRSA; and three globally important diseases: HIV, TB and malaria. It doesn’t examine the effect of resistance in other pathogens; and it doesn’t attempt to estimate either healthcare costs or secondary social costs (more on that below). So it is a conservative effort, several different ways. And yet, its baseline estimates of the size of the global problem are breathtaking. Among them: Antibiotic resistance currently accounts for an estimated 50,000 deaths in the US and Europe, which have surveillance to support those numbers. (The CDC puts the number for the US at 23,000.) But the project estimates that the actual current death toll is 700,000 worldwide. If antibiotic resistance were allowed to grow unchecked — that is, if there were no successful efforts to curb it or no new drugs to combat it (the latter is very plausible) — the number of deaths per year would balloon to 10 million by 2050. For comparison, that is more than the 8.2 million per year who currently die of cancer and 1.5 million who die of diabetes, combined. Those deaths would cost the world up to 3.5 percent of its total gross domestic product, or up to $100 trillion by 2050.Antibiotic resistance causes an apocalypse within 20 yearsIan Sample, 1-23-2013, "Antibiotic-resistant diseases pose 'apocalyptic' threat, top expert says," Guardian, 's most senior medical adviser has warned MPs that the rise in drug-resistant diseases could trigger a national emergency comparable to a catastrophic terrorist attack, pandemic flu or major coastal flooding. Dame Sally Davies, the chief medical officer, said the threat from infections that are resistant to frontline antibiotics was so serious that the issue should be added to the government's national risk register of civil emergencies. She described what she called an "apocalyptic scenario" where people going for simple operations in 20 years' time die of routine infections "because we have run out of antibiotics".Antibiotic resistance destroys every medical advancementDina Fine Maron, 4-30-2014, "Antibiotic Resistance Is Now Rife across the Globe," Scientific American, antibiotic-resistant bacteria and other pathogens have now emerged in every part of the world and threaten to roll back a century of medical advances. That’s the message from the World Health Organization in its first global report on this growing problem, which draws on drug-resistance data in 114 countries. “A post antibiotic-era—in which common infections and minor injuries can kill—far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century,” wrote Keiji Fukuda, WHO’s assistant director general for Health Security, in an introduction to the report. The crisis is the fruit of several decades of overreliance on the drugs and careless prescribing practices as well as routine use of the medicines in the rearing of livestock, the report noted.A2 ABRThe CDC and doctors are combatting antibiotic overuseCDC, 16. 5-3-16. (“CDC: 1 in 3 Antibiotic Prescription Unnecessary.” Center for Disease Control and Prevention – US Dept. of Health and Human Services. Accessed 8-2-7. JSD.)Health care professionals, health systems, and patients must take these actions to improve antibiotic use: Outpatient health care providers can evaluate their prescribing habits and implement antibiotic stewardship activities, such as watchful waiting or delayed prescribing, when appropriate, into their practices. Health systems can improve antibiotic prescribing in offices and outpatient facilities within their networks by providing communications training, clinical decision support, patient and health care provider education, and feedback to providers on their performance. Patients can talk to their health care providers about when antibiotics are needed and when they are not. These conversations should include information on patients’ risk for infections by antibiotic-resistant bacteria. Congress has recognized the urgent need to combat antibiotic resistance. In fiscal 2016, Congress appropriated $160 million in new funding for CDC to implement its activities listed in the National Action Plan for Combating Antibiotic-Resistant Bacteria. With this funding, CDC is fighting the spread of antibiotic resistance by: Accelerating outbreak detection and prevention in every state. Enhancing tracking of antibiotic use and resistance mechanisms and resistant infections. Supporting innovative research to address gaps in knowledge. Informing providers and the general public about antibiotic resistance and appropriate antibiotic use. Improving antibiotic use by supporting expansion and development of new programs and activities at the local level.Medicare penalizes antibiotic useJordan Rau, 16. 12-22-16 (Rau: Kaiser Health News. “Medicare Penalizes Hospitals in crackdown on Antibiotic Resistant Infections” NPR. Accessed 8-2-17. JSD.)The federal government has cut payments to 769 hospitals with high rates of patient injuries, for the first time counting the spread of antibiotic-resistant germs in assessing penalties. The punishments come in the third year of Medicare penalties for hospitals with patients most frequently suffering from potentially avoidable complications, including various types of infections, blood clots, bed sores and falls. This year the government also examined the prevalence of two types of bacteria resistant to drugs. Based on rates of all these complications, the hospitals identified by federal officials this week will lose 1 percent of all Medicare payments for a year — with that time frame beginning this past October. While the government did not release the dollar amount of the penalties, it will exceed a million dollars for many larger hospitals. In total, hospitals will lose about $430 million, 18 percent more than they lost last year, according to an estimate from the Association of American Medical Colleges.Alt cause – Nonhuman animal agricultureC. Ventola, 15. 4-15. (Ventola: Consultant Medical Writer. ”The Antibiotic Resistance Crisis: Part one – Causes and Threats” Pharmacy and Therapeutics (A peer reviewed journal for managed care and hospital formulary management). . Accessed 8-2-17. JSD.)In both the developed and developing world, antibiotics are widely used as growth supplements in livestock.5,10,14 An estimated 80% of antibiotics sold in the U.S. are used in animals, primarily to promote growth and to prevent infection.7,12,14 Treating livestock with antimicrobials is said to improve the overall health of the animals, producing larger yields and a higher-quality product.15 The antibiotics used in livestock are ingested by humans when they consume food.1 The transfer of resistant bacteria to humans by farm animals was first noted more than 35 years ago, when high rates of antibiotic resistance were found in the intestinal flora of both farm animals and farmers.14 More recently, molecular detection methods have demonstrated that resistant bacteria in farm animals reach consumers through meat products.14 This occurs through the following sequence of events: 1) antibiotic use in food-producing animals kills or suppresses susceptible bacteria, allowing antibiotic-resistant bacteria to thrive; 2) resistant bacteria are transmitted to humans through the food supply; 3) these bacteria can cause infections in humans that may lead to adverse health consequences.5 The agricultural use of antibiotics also affects the environmental microbiome.5,14 Up to 90% of the antibiotics given to livestock are excreted in urine and stool, then widely dispersed through fertilizer, groundwater, and surface runoff.5,14 In addition, tetracyclines and streptomycin are sprayed on fruit trees to act as pesticides in the western and southern U.S.1 While this application accounts for a much smaller proportion of overall antibiotic use, the resultant geographical spread can be considerable.1 This practice also contributes to the exposure of microorganisms in the environment to growth-inhibiting agents, altering the environmental ecology by increasing the proportion of resistant versus susceptible microorganisms.1 Antibacterial products sold for hygienic or cleaning purposes may also contribute to this problem, since they may limit the development of immunities to environmental antigens in both children and adults.1,15 Consequently, immune-system versatility may be compromised, possibly increasing morbidity and mortality due to infections that wouldn’t normally be virulent.15Nonhuman animal agriculture causes new deadly diseases to emerge and existing diseases to become antibiotic resistant.Charles Kenny, 3-31-2014, "The Economic Case for Taxing Meat," Bloomberg, meat’s impact on malnutrition, the livestock industry presents a growing global threat in its relationship with infectious disease. Domesticated animals have been the incubators of many of the world’s greatest killer diseases, from smallpox through measles to tuberculosis. The recent emergence of swine and bird flu suggests an increasing risk of pathogens jumping from the planet’s burgeoning domestic animal population to humans. We’ve added to that risk by regularly feeding factory animals antibiotics. Eighty percent of all antibiotics consumed in the U.S. are used on animals. This widespread use has been linked to the rapid emergence of antibiotic-resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), which kills 18,000 people a year in the U.S.Nonhuman animal agriculture is responsible for developing and transmitting resistant bacteria. It’s putting last resort antibiotics at risk.Dr. Michael Greger, 3-10-16, (physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues.) Antibiotic-Resistant “Superbugs” in Meat , the dire phrasing from head officials may be warranted. There are now infections like carbapenem-resistant enterobacter that are resistant to nearly all antibiotics, even to so-called drugs of last resort. Worryingly, some of these last resort drugs are being used extensively in animal agriculture. According to the World Health Organization, more antibiotics are fed to farmed animals than are used to treat disease in human patients. Doctors overprescribe antibiotics, but huge amounts of antibiotics are used in fish farming and other intensive animal agriculture, up to four times the amount used in human medicine. Why? “Suboptimum growth to slaughter weight caused by unsanitary conditions can be compensated with the addition of antibiotics to feed.” Instead of relieving any stressful overcrowded unhygienic conditions, it may be cheaper to just dose the animals with drugs. In this way, factory farms are driving the growth of antibiotic-resistant organisms that cause human diseases. “This may help bolster the industry’s bottom line, but in the process, bacteria are developing antimicrobial resistance, which affects human health.” The FDA reports that 80% of antimicrobial drugs in the United States are used in food animals, mainly to promote growth in this kind of high-density production. This can select for antibiotic-resistant bacteria like methicillin-resistant Staph aureus, or MRSA, considered a serious threat in the United States. These industrial pig operations may provide optimal conditions for the introduction and transmission of MRSA. U.S. pork producers are currently permitted to use 29 antibiotic drugs in feed—all without a prescription. Antibiotics are currently added to about 90% of pigs’ starter feeds. When animals receive unnecessary antibiotics, bacteria can become resistant to the drugs, then travel on meat to the store, and end up causing hard-to-treat illnesses in people.Econ NegECON DA2.5 million employed in insurance sectorStatista 17, “Number of employees in the insurance industry in the United States from 1960 to 2015 (in millions)”, 2017, statistic presents the aggregate number of employees in the insurance industry in the United States from 1960 to 2015. In 2015, there were approximately 2.5 million people employees in the insurance sector in the United States.526,000 Home-Office EmployeesStatista 17, “Number of health insurance home-office employees in the U.S. from 1960 to 2015*”, 2017, statistic represents the number of health insurance employees in the United States from 1960 to 2015. In 1999, there were 319,200 health insurance employees (home-office personnel) in the United States. Until 2015, this number increased to almost 526 thousand employees.Single payer would eliminate insurance companies/plan decreases the role of insurance companiesGood Day Sacramento 17, “Plan To Eliminate Insurance Companies, Give Health Care To All Californians Moves?Forward”, April 26,2017, California lawmakers pushed forward Wednesday with a proposal that would substantially remake the health care system of the nation’s most populous state by eliminating insurance companies and guaranteeing coverage for everyone. The idea known as single-payer health care has long been popular on the left and is getting a new look in California as President Donald Trump struggles to replace former President Barack Obama’s health care law. The proposal, promoted by the state’s powerful nursing union and two Democratic senators, is a longshot. But supporters hope the time is right to persuade lawmakers in California, where Democrats like to push the boundaries of liberal public policy and are eager to stand up to the Republican president. Hundreds of nurses clad in red rallied in support of the measure and marched to the state Capitol in Sacramento, packing the hallways before a Senate Health Committee hearing. Democrats on the panel voted to advance the measure. “By having everything in one pool, you’re going to decrease administrative costs, and you’re also going to get away from a system where so many different players in the system are there only because of greed, because they want to make money off of people’s health care needs,” said Thorild Urdal, a nurse in Oakland who is originally from Norway, which has government-funded health care. The measure would guarantee health coverage with no out-of-pocket costs for all California residents, including people living in the country illegally. Private insurers would be barred from covering the same services, essentially eliminating them from the marketplace. Instead, a new state agency would contract with health care providers such as doctors and hospitals and pay the bills for everyone.Health Insurance Employees Would Lose their JobsManson 17 (Melanie Mason covers state government and politics in Sacramento. She first began working for the Los Angeles Times in 2011 in Washington, D.C., where she covered money and politics during the 2012 presidential campaign. She is originally from Los Angeles and is a graduate of Georgetown University and the UC Berkeley Graduate School of Journalism.), “What would California's proposed single-payer healthcare system mean for me?”, LA Times, June 1, 2017, There’d be more upheaval for those who work in the insurance industry. Since the program would virtually eliminate the role of private insurance in the state’s healthcare market, the Senate analysis predicts that those workers “and many individuals who provide administrative support to providers would lose their jobs.”RecessionBrand 16 (Jennie E. Brand,?University of California – Los Angeles;), “The Far-Reaching Impact of Job Loss and Unemployment”, US National Library of Medicine National Institutes of Health, August 1, 2016, High levels of workers displacement marked the last four recessions in the U.S. The early 1980s recession convinced firms to utilize effective new equipment, shift production to modern plants, and lay off thousands of workers (Farley 1996).?Wetzel (1995)?wrote: “Industrial firms that had prided themselves on lifetime paternalistic commitments to their production workers – largely men with average or below-average educational attainment – slashed employment … The abrupt contraction struck at the heart of the middle class by drastically impacting mature family men with strong labor force attachment, good work histories, and long job tenure” (p. 101). The economic recovery of the 1980s was marked by large employment gains; nevertheless, unemployment persisted at a relatively high rate and newly created jobs were in general of a lower quality than jobs from which workers had lost. The early 1990s recession was marked by the creation of flat organization and elimination of middle management positions. High levels, particularly during economic recessions, of job loss and unemployment characterize the U.S. labor market since 1990. In the 1990s through early 2000s, worker layoffs, once regarded as organizational failure, were increasingly utilized as a labor allocative process available to firms in order to preserve shareholder value. Ensuing waves of downsizing, reorganization, mergers and takeovers rewarded some individuals with great prosperity while others were threatened with displacement, unemployment, and downward mobility (Baumol et al. 2003). The recessionary period from the end of 2007 to mid-2009, the “Great Recession,” was deeper and more extensive than any other since the Great Depression of the 1930s (Hout, Levanon, and Cumberworth 2011). The U.S. unemployment rate hovered around 9 to 10 percent in 2009–2011, the highest rate since the early 1980s recession and roughly twice the pre-crisis rate. The proportion of families with an unemployed member was roughly 12 percent in 2009, up from about 6 percent in 2007. The large increase in long-term unemployment in this most recent recession is suggestive of longer-term structural labor market changes (Katz 2010).Morah 17 (Chizoba Morah is an accomplished author and teaching assistant who specializes in accounting basics, personal finance and taxes. Currently an MBA student at Morgan State University, she is planning and looks forward to being the successful owner of her own accounting firm.), “What Causes a Recession?”, Investopedia, 2017, National Bureau of Economic Research?(NBER),?recession?is defined as "a significant decline in economic activity spread across the economy, lasting more than a few months, normally visible in?real gross domestic product?(GDP),?real income, employment, industrial production and wholesale-retail sales". More specifically, recession is defined as when businesses cease to expand, the GDP diminishes for two consecutive quarters, the rate of unemployment rises and housing prices decline.Impacts—Increased Suicide and Mortality RatesCatalano 13 (Ralph Catalano,?School of Public Health, University of California, Berkeley;), “The Health Effects of Economic Decline”, US National Library of Medicine National Institutes of Health, December 7, 2013, Job loss has been linked to both short and long-term declines in physical health, including worse self-reported health, physical disability, cardiovascular disease, a greater number of reported medical conditions, increase in hospitalization, higher use of medical services, higher use of disability benefits, an increase in self-destructive behaviors and suicide, and mortality (Burgard, Brand, and House 2007;?Catalano et al. 2011;?Dooley, Fielding, and Levi 1996;?Ferrie et al. 1998;?Gallo et al. 2000;?Gallo et al. 2004;?Gallo et al. 2006b;?Gallo et al. 2009; Kasl and Jones 2000;?Kessler, Turner, and House 1988;?McKee-Ryan et al. 2005;?Strully 2009;?Turner 1995). For example,?Gallo et al. (2004,?2006b)?found that job loss doubled the risk of subsequent myocardial infarction and stroke among older workers.?Sullivan and von Wachter (2009)?and?von Wachter (2010)?found a 50 to 100 percent increase in mortality the year following displacement and a 10 to 15 percent increase in mortality rates for the next 20 years.US prolonged recession leads to diversionary warsYulu 3Zhang, Viewpoint: Economic Recession-Blasting Fuse of Modern War, People’s Daily OnlineThe Iraq war has caused world people to think of many questions, one of which being the cause of war. Based on their analyses, many scholars and experts hold that the world political and economic unbalance is the factor that leads to war, but in the opinion of this author, Zhang Yulu, economic recession is the real fuse of modern war. If one examines the wars broken out ever since more than a century ago, one will discover an interesting phenomenon, that is, each fairly big economic recession (or economic crisis) was inevitably followed by the eruption of a war. This is true with World I, World War II, the Gulf War, as well as the Iraq war. It can be said that economic downturn is the blasting fuse of modern war. After the establishment of the capitalist system in Western countries, the market economy gradually replaced the natural economy to hold a dominant position. The market economy, more often than not, presented itself as a "surplus economy". The economic crisis is the result of this kind of relative excess and a passive method for eliminating the excess. During the period of recession, there are sharp social contradictions, stockpiling commodities and declining production, under this circumstance, the State must bear the responsibility to eliminate excess and stimulate production. The most effective method. The interactions of the two major forces--the sharp domestic contradictions and the expansion of military strengths-are bound to cause certain big powers to cherish the motive to lift themselves out of the "quagmire" of recession by relying on war. No wonder before the Iraq war completely came to an end, certain American "experts" began to calculate how large a role the Iraq war could play for US economic recovery. As a matter of fact, the United States is quite experienced in making a big fortune out of war and making use of war to remedy recession. World War I helped the United States to secure its throne as the world's number one power, World War II helped it to attain the position as a superpower. Victory in the Gulf War, to a certain extent, helped bring about a "new economy" and a period of 10-year-long economic prosperity for the United States. Owing to US military might, many countries have attached themselves to or are dependent on America politically and militarily, as a result, US hegemony pushes its way through, thus objectively making the United States become the country enjoying the most "stability" in the world. US present economic difficulty is associated with the declining investment rates resulted from enterprises' overproduction capacity and companies' accounting scandals, thus laying bare the aspect of false prosperity of its "new economy", but the most direct fuse of US economic recession is the "9.11" incident, it exposes the weakness of the US "security system", predicting that the "investment paradise" is facing challenges. So, in a certain sense, American economic recession is caused by the threat to its hegemony, not purely due to economic factors. The US government is well aware of the relations among US economic prosperity, its security and world security, the United States holds that to maintain US economic prosperity, it is essential to ensure national security, restore the "investment paradise" position and create neither too big nor too small troubles to the world, leaving other parts of the world in a state of "controlled" insecurity. Only by doing so, can the United States "gain benefits as can a fisherman". That's why the United States is going all out to attack "terrorism" at all costs, which presently poses the greatest threat to the country; blockade so-called disobedient "axis of evil countries", guard against potential competitors such as China, Russia and Europe, and reestablish a "secured islet". The Afghanistan war produced the effect of "killing three birds with one stone", dealt a heavy blow to terrorism and at the same time helped US influence to penetrate into regions close to China and Russia. Guided by this policy and inspired by victory gained in the anti-terrorism war, the United States started attacks on Iraq in defiance of world people's strong anti-war cries. This action was neither taken out of the emotional impulse of President George W. Bush, nor was it taken purely for oil interests. The disintegration of the Soviet Union once greatly excited some people who thought that war danger had decreased with the conclusion of the Cold War. Now it turns out that the world dominated by one superpower is more disquiet than it is faced with the contest between two powers for hegemony. The world is analogous to a scale that can be balanced only when things on both ends are of equal weights, change in the weight on one end means the loss of balance. After the break-up of the Soviet Union, the strength restraining the United States has been weakened, multi-polarization is in the process of development, the United States, being the sole superpower, increasingly likes to speak in a "Tomahawk" way. Especially when the tranquillity of various countries has begun to be linked up with the performance of the US economy, as a "folk prescription" for remedying US economic recession, war has become a "good recipe". The United States has repeatedly drawn benefits from its military might, so it has made up its mind to maintain its military leading position. As soon as he took office, President Bush declared his intention to build an "unmatchable" military force, and approved the defense budget totaling US$310 billion for 2001 and the country's budgeted military spending reached as high as US$392 billion for 2003, even higher than the combined total of other 20 military powers. An additional war fund worth nearly US$80 billion was put in during the Iraq war. It seems that the dose of fitness "desperate cures" of the United States will continuously be put into use. SOLVENCY (if plan still has private insurers around)Doctors Deny Patients Who Have Medicaid/Medicare/TURN—increase exacerbate racial inequality Shapiro 17 (UCLA BA in Poli Sci, Harvard Law, Daily Wire Editor), “Sanders Says Trumpcare Will Kill Millions. Here are Three Reasons That’s a Lie”, The Daily Wire, March 14, 2017, People on Medicaid suffer from worse health outcomes than those who don't have insurance at all. This is because a lot of doctors don't accept Medicaid since it drastically underpays doctors; leaving those on Medicaid forced to wade through the bureaucratic quagmire to find a doctor that does. There have been studies conducted that confirm this: A University of Virginia study found that Medicaid patients hospitalized for major surgery were actually 13% more likely to die in the hospital than those without any health insurance. Likewise, the National Cancer Institute found that late-stage prostate cancer, late-stage breast cancer, and late-stage melanoma were actually much more common in Medicaid recipients than in the uninsured. And a Johns Hopkins study of patients receiving lung transplants found that Medicaid patients were 29% more likely to die within three years. What's more, a University of Pennsylvania study (published in the journal Cancer) found that colon cancer patients with Medicaid had a higher mortality rate than uninsured patients, and a higher rate of surgical complications. And these findings hold up even when you correct for age and socioeconomic status. One heartbreaking example that demonstrates this was 12 year-old Deamonte Driver. He had a toothache that later turned into an infection that spread to his brain because his mother was unable to find a dentist that took Medicaid before the infection occurred. She also couldn't find a neurologist to treat the infection; consequently Deamonte Driver had to be taken to the hospital, where he passed away from the infection.Doctors Don’t Accept MedicaidBandler 17 (Aaron Bandler is a staff writer for The Daily Wire. He is a graduate from Cal Poly San Luis Obispo with a Journalism degree and an Economics minor, and has previously written for , The Daily Caller, and the?Santa Barbara News-Press.) “If Obamacare Was So Great, Why Did Life Expectancy Drop Last Year?”, The Daily Wire, March 14, 2017, Nearly Everyone Who Loses Insurance Under Trumpcare Is On Medicaid. Medicaid is government sponsored health care. And most doctors don’t take it. As Jim Geraghty notes, “As of 2015, only 67 percent of doctors take Medicaid, and only 45 percent of doctors take new patients on Medicaid.” And according to the Oregon Health Insurance Experiment, as Geraghty also notes, Medicaid does not improve medical outcomes by any real metric. It did not decrease ER visits; in fact, it increased it. While Medicaid users received more diagnostic care, the study found that it “had no statistically significant effect on several measures of physical health,” including blood pressure, cholesterol, or cardiovascular risk. As the Manhattan Institute reports: The best statistical estimate for the number of lives saved each year by the Affordable Care Act (ACA) is zero. Certainly, there are individuals who have benefited from various of its provisions. But attempts to claim broader effects on public health or thousands of lives saved rely upon extrapolation from past studies that focus on the value of private health insurance. The ACA, however, has expanded coverage through Medicaid, a public program that, according to several studies, has failed to improve health outcomes for recipients. In fact, public health trends since the implementation of the ACA have worsened, with 80,000 more deaths in 2015 than had mortality continued declining during 2014–15 at the rate achieved during 2000–2013. ................
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