Is Private Healthcare Harmful to the Poor? Ask DGHI Student Debaters!

March 02, 2016
Gavin Yamey setting up debate
Professor Gavin Yamey sets up the students at the beginning of the debate.

By Caesar Lubanga-kene, 1st-year MSc-GH student

On February 4, a Duke Global Health Institute (DGHI) debater’s club was born. 

Students in Dr. Gavin Yamey’s global health policy class debated the motion, “private healthcare is harmful to the poor.” They engaged in a heated exchange of ideas in front of a live audience composed of fellow students, staff and faculty, including the founding director of DGHI, Dr. Michael Merson

The audience listened carefully to the academic discourse on health disputes while sipping tea and munching on tasty homemade scones, thanks to the generosity of Dr. Yamey’s family and teaching assistant Sulzhan Bali. In the end, the audience voted against the motion by 12 votes to 8.

The debate was the brainchild of Dr. Yamey, a new member of the DGHI family. Dr. Yamey, professor of the practice of global health, is an alumnus of Oxford University, where he trained in clinical medicine. While at Oxford, he was an active member of the Oxford Union, one of the oldest and most august debating societies and unquestionably the world’s most prestigious debate club.

The DGHI debate was modeled on the Oxford Union debate style, in which the “opposers” and “proposers” of the motion sit on different sides of the floor with a chairperson in the middle of the house who moderates and controls the discussions, including time keeping. For this debate, dedicated teaching assistants Sulzhan Bali and Jihad Abdelgadir served as moderators.

Dr. Yamey decided to have his students debate this motion—“private healthcare is harmful to the poor”—as a precursor to a lecture on a common topic: private vs. public health care. The class was divided up into speakers “for the motion” (proposers) and those “against the motion” (opposers). 

Below are a few of the notable points that were addressed during the debate and Q&A session:

  • Health care in the private sector is chaotic and “evil”
  • Not all private players are “evil”
  • Private health care and the private sector are unregulated
  • The private sector supports the local and public health system by filling the gap
  • Private health care is limited in scope and cannot scale
  • Usually the private sector has more funding to invest in health than the public sector
  • The private sector has no incentive to provide health to the poo
  • Private health care is more efficient
  • Private health care is profit oriented and very expensive
  • Good health is not free and is very expensive
  • Private health care only covers the rich
  • Private health care can be made affordable by different financing mechanisms like insurance
  • Cuba and UK are great examples of the potential of non-private health care
  • Private-public partnerships work best

Proposer Dillion Isaac and opposer Michelle Roberts submit their arguments on the floor of the house.

But at last, the debate proved one thing: there are many challenges and solutions to the countless global health problems around the world. The best intervention may be murky, but selling a viewpoint to your audience is the key. 

In his essay “Agendas, Alternatives, and Public Policies, 1984,” the acclaimed policy scholar John Kingdon writes:

  • There are many ways to understand and frame any policy problem, but the policy agenda can often be dominated by one ‘frame’.
  • There are many problems to solve, but few reach the top of the policy agenda.
  • There are many possible solutions to problems, but very few gain attention and even fewer gain support.

He adds that "actors have limited resources such as time and cognitive ability. This limitation forces people to make choices before they have considered all possibilities and made sure that their preferences are clear."

The main actors, in this case the audience, were indeed presented with two strategies for health care provision by two tough groups competing for their affinities. They had a decision to make based on each side’s presentations. 

In a democratic approach, the audience, which is credited for fair attendance and patience during the debate, out-voted public health care in favor of the private sector by 4 votes. The house chairpersons hence ruled in favor of the opposers that private care is not harmful to the poor. 

This is a classic challenge faced by global health professionals in the hunt for public support of noble strategies for health policy. In the words of the renowned businesswoman and author Margaret Heffernan, “for good ideas and true innovation, you need human interaction, conflict, argument, debate.” 

After the success of this event, many DGHI students are hoping to see more formal debates as part of the robust Duke Global Health events lineup. We hope formal debates persist at the institute to secure appropriate action for sustainable global health.