Obamacare is constitutional

June 29th, 2012 at 11:00 am by David Farrar

A big relief for Obama today. Reuters reports:

The US Supreme Court has upheld President ’s healthcare law in an election-year triumph for him and fellow Democrats and a stinging setback for Republican opponents of the most sweeping overhaul of the unwieldy US healthcare system in about a half century.

In a 5-4 ruling based on the power of Congress to impose taxes, the court preserved the law’s “individual mandate” requiring that most Americans obtain health insurance by 2014 or pay a tax.

Opponents of the law had argued the mandate was an overreach by the federal government into the private lives of citizens. The court was deeply divided on this issue, but the majority ruled that Congress’ taxing power was more important.

The law’s “requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax,” Chief Justice John Roberts wrote for the court’s majority.

“Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness,” wrote Roberts, who was joined by the four most liberal members – Justices Ruth Bader Ginsburg, Stephen Breyer, Elena Kagan and Sonia Sotomayor – in upholding the law’s key provision.

Very interesting that the Chief Justice voted with the liberal wing.

This is definitely good news for Obama. Having his major domestic achievement thrown out would have meant he would have very little domestic achievements to campaign on.

However I do find it hilarious that the left celebrate Obamacare as a huge victory for socialised medicine and the like. If a Republican President had proposed the key tenet of Obamacare, I suspect it would be decried around the world as vicitimising the poor.

You see Obama failed to get a law through which set up taxpayer funded healthcare as in the UK, Canada and New Zealand.

What he passed was basically a law saying it is illegal not to have private health insurance and we will fine you, if you don’t get some. Someone on Twitter said:

Oh no, poor people will get proper health care and avoid dying earlier?

Which I thought demonstrated they had no idea what the law actually does. The individual mandate does not extend health care to poor people. It fines poor people for not having health insurance.

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80 Responses to “Obamacare is constitutional”

  1. Paulus (2,607 comments) says:

    Like the Clinton legislation heavily supported by the Senator for Illinois whereby a mortgage could not be refused – despite any ability to pay the mortgage, which is called Sub Prime, as mortgage lenders eg Fanny Mae and Freddy Mack and others had to go borrow money from the market. They had totally insufficient funds to provide mortgages which was required under law. They along with many others went truly bust.
    The Senator ?? one B Obama
    Now the same trick – “the law says that you must give me medical Insurance – but I cannot pay the premiums – (possibly because I do not have a job).
    Can see only more financial ruin in USA. – that’s vote buying socialism, like interest free student loans, and working for families.

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  2. kowtow (8,323 comments) says:

    And the SC got around the “fine” by calling it a “tax”. More legal gobbledegook. More growth of the state.

    This might be a great decision,it will fire up the opposition.

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  3. metcalph (1,428 comments) says:

    The individual mandate does not extend health care to poor people. It fines poor people for not having health insurance.

    Not correct. Poor people have access to Medicaid as of right. The fine/tax will fall on the middle class.

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  4. East Wellington Superhero (1,151 comments) says:

    I don’t understand. Can someone who knows, please connect the dots for us. Compulsory insurance? What if you don’t pay? Surely the government must be picking up the tab somehow?

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  5. East Wellington Superhero (1,151 comments) says:

    Does the fine/tax come from general taxation, not an individually paid premium?

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  6. East Wellington Superhero (1,151 comments) says:

    Does the law make it illegal from medicaide not to cover everyone? I don’t understand.

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  7. Mark (496 comments) says:

    Obamacare is a massive theft of wealth from poor people to pay for overpriced health care plans that they do not require so wealth seniors are subsidised by poor people to get lower cost health care.

    This is not a victory for poor people but for a massive wealth transfer to rich elderly people.

    Obamacare will now be decide at the ballot box, with Rommey now being able to bash Obama over the head with from now until Nov. Over 70% of Americans thought the Supreme Court should of overturned Obamacare.

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  8. swan (665 comments) says:

    Another 5-4 split eh. I take it from that, that constitutional can mean whatever you want it to mean.

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  9. metcalph (1,428 comments) says:

    Medicaid is only for poor people.

    You now have to have some sort of health insurance. If you don’t then you get taxed.

    The problem is that the tax is not as large as the average health insurance premium and it goes to the government rather than the insurers.

    Since the insurers are going to need more clients to cover the people with pre-existing conditions they will be forced to take, they are going to fall short unless the government pays the shortfall. Yeah right.

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  10. Manolo (13,580 comments) says:

    The Obama administration has been given a poisoned chalice. Out with the Messiah in November.

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  11. metcalph (1,428 comments) says:

    Obamacare is a massive theft of wealth from poor people to pay for overpriced health care plans that they do not require so wealth seniors are subsidised by poor people to get lower cost health care.

    The seniors are already covered by medicare (not medicaid). Obamacare or Obamatax does nothing to affect this.

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  12. cha (3,943 comments) says:

    I don’t understand. Can someone who knows, please connect the dots for us. Compulsory insurance? What if you don’t pay? Surely the government must be picking up the tab somehow?

    http://www.buzzfeed.com/zekejmiller/romneycare-included-tax-to-ensure-participation

    For those that have higher incomes, we expect them to have health insurance. And if they don’t we’re going to withhold their tax refund or put in place other penalties to assure that everybody comes in the system.

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  13. tvb (4,364 comments) says:

    No – it fines people for NOT having health insurance poor or otherwise. And if they cannot afford it the Government steps in. But the very rich or even wealthy can self insure so it seems a bit silly for people with huge resources to buy insurance when they can afford to pay as the need arises. But this is a big win for Obama. Parts of Obamacare are very popular and now the constitutional issues are settled Obama can campaign hard for the plan. The Chief Justice made the very important point that it is not the role of judges to get into policy matters, that is for the politicians. They confine themselves as to whether it is constitutional for the Federal Government which does have limited powers are prescribed in the constitution I think we will hear more on this point for the Chief Justice as he swings left or right on various issues.

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  14. KevinH (1,219 comments) says:

    Excerpts from the New York Times:

    “The Affordable Care Act’s requirement that certain in­dividuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax,” Chief Justice Roberts wrote in the majority opinion. “Be­cause the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.”

    The court did substantially limit a major piece of the law, one that expanded Medicaid, the joint federal-state program that provides health care to poor and disabled people. Seven justices agreed that Congress had exceeded its constitutional authority by coercing states into participating in the expansion by threatening them with the loss of existing federal payments.

    In the opinion, Chief Justice Roberts wrote that the decision offers no endorsement of the law’s wisdom, and that letting it survive reflects “a general reticence to invalidate the acts of the nation’s elected leaders.”

    http://www.nytimes.com/2012/06/29/us/supreme-court-lets-health-law-largely-stand.html?_r=1&emc=na

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  15. Weihana (4,496 comments) says:

    Mark,

    Obamacare is a massive theft of wealth from poor people to pay for overpriced health care plans

    Great, so you too want universal health coverage? Get the republicans on board and then we can have real reform. In the meantime, the individual mandate is a reasonable way to broaden the base to achieve affordable care.

    health care plans that they do not require…

    Sorry but anyone who thinks they do not require health coverage is an idiot. At least in NZ we have a universal system but still I’m glad I also have private coverage. I’m not old either.

    In the US about half of bankruptcies cite medical causes as a factor. But hey, who needs coverage?

    Over 70% of Americans thought the Supreme Court should of overturned Obamacare

    Crap. Rasmussen Reports is reporting 54%, unchanged from when the law passed.

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  16. Paul Williams (878 comments) says:

    David, you may not be aware that the Australian system is a bit of a hybrid in so far as individuals’ earning an income over certain levels (vary by age and family status) either pay a surcharge or must take out private medical insurance. On your broader point about the nature of Obama’s win, I’d say two things. It is more than sufficient to campaign on and it provides a platform to extend cover.

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  17. Kovac (29 comments) says:

    “If a Republican President had proposed the key tenet of Obamacare, I suspect it would be decried around the world as vicitimising the poor.”

    Mitt Romney the Republican nominee was supporting a mandate long ago. As were many other people in the Republican party.

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  18. KiwiGreg (3,249 comments) says:

    “Sorry but anyone who thinks they do not require health coverage is an idiot. ”

    It’s a perfectly rational choice if you are young and healthy. It’s precisely because it is a rational choice for the healthy that they need the penalties for not taking up “insurance”. Because insurers are prohibited from declining coverage to the already ill the system can only work if the healthy are forced into it to lower the costs for the ill.

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  19. KiwiGreg (3,249 comments) says:

    I like some of the reporting about “popular” elements of Obamacare – like requiring employers to allow children up to the age of 26 stay on their parent’s plans. Seriously WTF? You’re a child in America if you’re 26???

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  20. Weihana (4,496 comments) says:

    KiwiGreg,

    I disagree. It’s irrational. It’s the attitude of wait until the last minute and then try to get help… oops can’t afford it, file for bankruptcy. The fact that people act a certain way does not make it rational. If nothing unexpected happens at the very least everyone gets old.

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  21. wikiriwhis business (3,883 comments) says:

    Americans have just been doomed to incarceration for being poor

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  22. wikiriwhis business (3,883 comments) says:

    ‘You’re a child in America if you’re 26???’

    The current debate in the US is raising the age of marriage to 25

    Obviously, anyone under 21 pursuing sex will be deemed a pedophile.

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  23. Scott Chris (6,060 comments) says:

    It’s the attitude of wait until the last minute and then try to get help… oops can’t afford it, file for bankruptcy.

    But that isn’t irrational behaviour in my book Weihana. Socially irresponsible maybe..

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  24. berend (1,705 comments) says:

    Best interpretation I’ve read so far, some quotes:

    First of all, placing the ACA under the Taxation power instead of the Commerce power places greater limits on how that power can be used and dramatically softens the penalty for non-compliance (you simply pay a tax, you cannot be jailed or otherwise punished for failure to purchase health insurance). Congress cannot compel you to purchase insurance; it can only compel you to pay a non-extreme, non-coercive tax if you wish not to purchase insurance. Second, by laying waste to the Commerce Clause argument and making clear that this sort of thing can only be done through the taxation power, the decision may make it harder to pass these sorts of laws in the first place.

    Read it all as they say.

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  25. Weihana (4,496 comments) says:

    Scott Chris,

    But how does one know when they are going to need health care? Being young and healthy may mean the chances are low but one is still gambling with their health coverage, and if they go bankrupt they are not just being socially irresponsible, but they are ruining their lives. Health to me is so fundamental to one’s life that I cannot see how one can rationally choose to go without coverage, even if the relative risk is low.

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  26. RRM (9,834 comments) says:

    In that country, you can stagger into the emergency department with your hand hanging off your arm by a sinew, and they will turn you away if you aren’t insured or signed up with the proper people.

    It’s just a fucked up beyond belief situation. Even the villages of primitive nomadic tribes find ways to take care of their sick, but the greatest country on earth cannot or will not.

    And astonishingly, there is a huge lobby of “hands off my taxes” people who fight tooth & nail against any move to change this. Glad I don’t live there…

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  27. Harriet (4,857 comments) says:

    It was doomed from the start.

    90% were already covered by private health insurance.

    The remainder -about 40 mil- were made up of 15 mil who were between jobs, and would have private healthcare in the immediate future once they returned to work.

    Another 20 mil were illegal aliens, and arn’t entitled to healthcare in any form whatsoever anyway.

    That left about 5 mil – to face off against 250 mil who were against Obama’s socialist health system.

    Quess who raised all the important questions ?

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  28. tas (623 comments) says:

    Obamacare is a reasonable approximation to universal healthcare. About time. It’s a disgrace that in a wealthy country like America, so many people are left without healthcare or go bankrupt paying for it. Or, in some cases, people are abandoned by their insurance when they get sick. I know it isn’t very libertarian, but you have to be pretty ideological to think that Obamacare is worse than the status quo.

    Remember public heathcare spending in the US is higher than in NZ relative to GDP, but NZ has universal healthcare, while the US does not. The US system is totally dysfunctional.

    There is one reasonable objection to Obamacare that I have heard: Healthy people will buy minimalist insurance. When they get sick, they’ll buy premium insurance. Since Obamacare prevents refusing coverage based on pre-existing conditions, there is nothing to stop them doing this. So the minimalist insurance company only has healthy customers and thus makes a killing. The premium company only has sick customers and goes broke. So the fear is that quality of US health coverage will be reduced to the lowest common denominator.

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  29. Scott Chris (6,060 comments) says:

    Health to me is so fundamental to one’s life that I cannot see how one can rationally choose to go without coverage, even if the relative risk is low.

    Weihana, I think it depends on how you choose to assess and mitigate that risk and more importantly – how much you stand to lose. Knowing that your risk is low and knowing that the premium you are paying is subsidising those who have pre-existing conditions may persuade you to take your chances being uninsured knowing that in the unlikely event you meet with misfortune that you still have the option of declaring bankruptcy.

    I mean, what proportion of youngish people in the States have a net worth close to zero?

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  30. berend (1,705 comments) says:

    RRM: In that country, you can stagger into the emergency department with your hand hanging off your arm by a sinew, and they will turn you away if you aren’t insured or signed up with the proper people.

    Clearly you don’t know what you’re talking about.

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  31. Harriet (4,857 comments) says:

    Tas#

    But the ‘quality’ of healthcare received by individual private patients in the US is better than in NZ.

    And that is what ‘delivery’ in the private sector is all about – as you are buying ‘your own’ insurance.

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  32. Weihana (4,496 comments) says:

    public heathcare spending in the US is higher than in NZ relative to GDP, but NZ has universal healthcare, while the US does not. The US system is totally dysfunctional.

    NZ spends 10.3% of GDP, the US spends 17.4%.

    Per capita PPP US dollars, the US spends $7,960, New Zealand spends $2,983

    Woe betide the country that adopts socialized medicine! :)

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  33. berend (1,705 comments) says:

    tas: Remember public heathcare spending in the US is higher than in NZ relative to GDP, but NZ has universal healthcare, while the US does not. The US system is totally dysfunctional.

    Lower your healthcare cost is easy: just let people die when they need the system. The NZ system is disgraceful. Yes, costs are lower than the US, but it’s one big lie, because people think the government is there when they need it. The bereaved usually find out the hard way.

    The only way government can control healthcare costs is by rationing. You want to sign the decisions over your life away to a bureaucrat?

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  34. berend (1,705 comments) says:

    Weihana: Woe betide the country that adopts socialized medicine!

    Controlling costs is easy. Getting care when you need it, is a very different story.

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  35. Weihana (4,496 comments) says:

    Scott Chris (4,356) Says:
    June 29th, 2012 at 1:04 pm

    Weihana, I think it depends on how you choose to assess and mitigate that risk and more importantly – how much you stand to lose. Knowing that your risk is low and knowing that the premium you are paying is subsidising those who have pre-existing conditions may persuade you to take your chances being uninsured knowing that in the unlikely event you meet with misfortune that you still have the option of declaring bankruptcy.

    I mean, what proportion of youngish people in the States have a net worth close to zero?

    Well I guess it was quite the overstatement to suggest anyone making this judgment call is an idiot, but I don’t quite see bankruptcy as an option one should want to entertain.

    Moreover, as I understand it in the United States only emergency care is mandated regardless of ability to pay, which means you have to wait until your condition is really bad and they’ll provide you with some treatment.

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  36. mikenmild (11,247 comments) says:

    Both a socialised system or an insurance system will ration healthcare. In a socialised system the rationing is done by limiting the level of care offered; in an insurance-basef system the rationing is by way of what klevel of insurance care you are able or willing to buy. Either you put up with the public-health bureaucrats’ or you put up with the insurance-company bureaucrats’ rules.

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  37. KiwiGreg (3,249 comments) says:

    “In that country, you can stagger into the emergency department with your hand hanging off your arm by a sinew, and they will turn you away if you aren’t insured or signed up with the proper people.”

    Utter crap. So much of what NZers think about US health care is just plain wrong.

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  38. berend (1,705 comments) says:

    mikenmild: in an insurance-basef system the rationing is by way of what klevel of insurance care you are able or willing to buy.

    That’s nonsense milkenmild. Claiming that your alcohol consumption is rationed by the amount you are able to afford is not how rationing is defined in my dictionary.

    Yes, your ability to pay has an impact on everything you do. You would be consistent to claim that would be a reason to limit taxes. But somehow I doubt you think that taxes have a severe impact on your choices.

    You have some kind of point that yes, your insurance company can screw or limit you, but in a market you have a choice. And you can choose not to purchase insurance, but buy healthcare directly.

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  39. Weihana (4,496 comments) says:

    Harriet (241) Says:
    June 29th, 2012 at 1:06 pm

    Tas#

    But the ‘quality’ of healthcare received by individual private patients in the US is better than in NZ.

    According to whom?

    http://www.commonwealthfund.org/News/News-Releases/2010/Jun/US-Ranks-Last-Among-Seven-Countries.aspx

    U.S. Ranks Last Among Seven Countries on Health System Performance Based on Measures of Quality, Efficiency, Access, Equity, and Healthy Lives

    United States ranks 6 out of 7 (behind NZ) on overall quality.

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  40. Weihana (4,496 comments) says:

    berend,

    Claiming that your alcohol consumption is rationed by the amount you are able to afford is not how rationing is defined in my dictionary.

    Ration is defined as:

    “a limited amount of something which one person is allowed to have, especially when there is not much of it available”

    So yes consumption of alcohol is rationed by price. Of course a pint of beer is somewhat cheaper than open-heart surgery hence why the notion of it being rationed by affordability is somewhat absurd.

    …but in a market you have a choice. And you can choose not to purchase insurance, but buy healthcare directly.

    I think you mean the wealthy have a choice. The poor do not. Prices do the rationing in a market. There is ALWAYS rationing in every economy.

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  41. Psycho Milt (2,411 comments) says:

    …Obama failed to get a law through which set up taxpayer funded healthcare as in the UK, Canada and New Zealand.

    So the resulting compromise mess is his fault because he “failed to get a law through” for a more sensible system? Did you pause for a moment to ponder the cause of that failure?

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  42. metcalph (1,428 comments) says:

    In that country, you can stagger into the emergency department with your hand hanging off your arm by a sinew, and they will turn you away if you aren’t insured or signed up with the proper people.

    A absolute lie. Hospitals are required by federal law to treat such people. The problem is with chronic conditions or effects from the initial treatment.

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  43. Weihana (4,496 comments) says:

    It’s a common myth that US hospitals will turn away people requiring emergency treatment. Probably to do with movies that exaggerate for comedic or dramatic effect.

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  44. RRM (9,834 comments) says:

    A absolute lie. Hospitals are required by federal law to treat such people.

    My bad.

    It’s an amazingly persistent urban myth then – almost like there’s a gap in between what they are “required by law” to do, and what they actually do…

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  45. Harriet (4,857 comments) says:

    Weihana #

    “….U.S. Ranks Last Among Seven Countries on Health System Performance Based on Measures of Quality, Efficiency, Access, Equity, and Healthy Lives…United States ranks 6 out of 7 (behind NZ) on overall quality….”

    I’m talking about health insurance that an ‘individual’ buys – people don’t buy ‘rankings’ – but simply use them to make a decision when buying health insurance.

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  46. berend (1,705 comments) says:

    Weihana: So yes consumption of alcohol is rationed by price.

    Glad you admitted that your definition was nonsense. That’s not rationing.

    Weihana: Of course a pint of beer is somewhat cheaper than open-heart surgery hence why the notion of it being rationed by affordability is somewhat absurd.

    But why would it? A computer that is far superior than anything in the 70s is so affordable even the poor can afford it (i.e. your phone). If the market is allowed to work, it works, noticed?

    Obviously new procedures will be very costly initially, but the market is very good in bringing prices down. Many in this country purchase health care without insurance for many routine procedures and at modest cost (some thousands).

    And is being poor a disease? Or a result of not being diligent at school?

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  47. Fletch (6,295 comments) says:

    Actually, the U.S already had the best health care system in the world before Obamacare.
    It’s a liberal lie that the U.S was 37th best on the world or whatever. The WHO study those figures came from was based on how socialised a country’s medicine was, not how well people were treated (duh).

    Chait moves on to his empirical linchpin to prove his point that “empirical reasoning simply does not drive [conservative] thinking. What appears to be conservative economic reasoning is actually a kind of backward reasoning. It begins with the conclusion and marches back through the premises.” He goes on:

    Consider the conservative view of health care. Conservatives repeat the mantra that the United States has “the best health care system in the world”—a formulation used endlessly by President Bush. That isn’t true by almost any objective measure. The United States devotes a far higher share of its economy to health care than any other country. Yet, according to the most recent World Health Organization study, the United States ranks just 37th in overall health care performance.

    And what did the study actually, er, study?

    I am relying on the work of Scott W. Atlas, a senior fellow at the Hoover Institution and professor of radiology and chief of neuroradiology at Stanford Medical Center when I say that the lengthy WHO study Chait uses to prove the empiricism of liberals might be the worst study ever. This is what Atlas concludes, or at least that’s what I take him to be saying, in his article titled “The Worst Study Ever?” He calls it “an intellectual fraud of historic consequence—a profoundly deceptive document that is only marginally a measure of health-care performance at all. The report’s true achievement was to rank countries according to their alignment with a specific political and economic ideal—socialized medicine—and then claim it was an objective measure of ‘quality.’”5

    To take one small example: A full 25 percent of a health-care system’s final score in the WHO study is derived from what it calls a health-care system’s “Financial Fairness.” Essentially, the more socialized a system is—with the wealthy paying more through taxation—the better it is. Indeed, Atlas shows that “almost two-thirds of the study was an assessment of equality. The actual health outcomes of a nation, which logic dictates should be of greatest importance in any health-care index, accounted for only 25 percent of the weighting. In other words, the WHO study was dominated by concerns outside the realm of health care.” Oh, and the data behind these rankings weren’t even empirical. Rather than collect hard numbers about health outcomes or anything else, these rankings were weighted by polling the impressions of “key informants” in the health-care profession, half of whom were WHO staff and had a bias toward state-run health-care systems. At least that’s my reasonable guess (if the World Health Organization bureaucracy is a hotbed of free-marketers, I’ll be glad to retract). As Atlas suggests, a reasonable person, even an avowed empiricist, might think a ranking of health-care systems would score the quality of the health care those systems provide and not how successful they are at redistributing costs.

    Conversely, it is true that America has the best health-care system in the world in some ways and not in others. For example, if you are very ill and/or very rich things look better here than pretty much anywhere else. Saudi kings and Chinese billionaires come to the United States when they are sick because they know this. If you have a bad heart or a scary cancer diagnosis, America is where you go to seek treatment. And if you’re already in America, you have a better chance of surviving such a diagnosis than you do elsewhere. Our overall cancer survival rates beat every industrialized country in the world.6 We beat Canada—glorious Canada!—when it comes to preventative care.7 In other words, what you think of our health-care system depends at least to a significant degree on how you define best. And that depends to a great extent on your ideological preferences.

    Jonah Goldberg (2012-04-30T12:00:00+00:00). The Tyranny of Cliches (Kindle Locations 528-535). Penguin Group US. Kindle Edition.

    More – http://www.commentarymagazine.com/article/the-worst-study-ever/

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  48. Fletch (6,295 comments) says:

    ps, today’s decision was terrible. Obama pretty much wiping his *** on the Constitution. So, it’s a tax now? That’s how the Judge defined it, after Obama previously said it was not a tax.

    It could be good for the upcoming election, anyway. Here’s what White House Insider says –

    The Obamacare ruling is good news for us.  Real good news.  It’s 2010 all over again now.  Swing states will shift over to Romney in most cases.  Trust me on this.  We’ve done the polling.  The data is conclusive on this.  It’s a huge tax.  We got Obama lying.  Again.

    The Tea Party movement, which was as real and powerful a political movement as I’ve ever seen in my lifetime, is back in play.  That scares the hell out of the Obama White House.  You just got a bunch of Dems sweating hard over their re-election.  The Republican Party will now be a lot more focused and clearly conservative and that’s exactly what they need to be this time around.  We must make the election a clear divide between one side and the other and this Obamacare ruling has forced that to happen.

    And the initial reports I’m getting are telling me there was a lot more clever going on inside that decision than the initial reaction will indicate. It’s the Obama Tax now.  And states were given an out.  The entire law is a big ass convoluted mess and the ruling has reinforced that fact.  Obama will have to defend something he doesn’t understand, and Romney can now sit back and just repeat over and over again “repeal-repeal-repeal”.

    You can call bullsh-t on me here and I’ll understand if you do but I’m telling you right up this ruling today is GOOD NEWS.  Politically,  as a motivator, it’s great news.  Watch contributions toward Republicans jump up even more than they already were.  Watch the Obama White House have to face very hard questions over the Obamacare tax issue.  Watch states rise up to challenge the administration using the weapon the Supreme Court placed in their hands to do so. Watch the Tea Party come back stronger and more powerful than ever.

    The giant has woken up.  Country needed a hard kick in the ass to remind us what is at stake in November.  Now we are truly ready to fight.

    Last thing.  Romney was preparing for this decision.  He gets to go with the better script now.  He’s coming out swinging hard on this one. 

    Chin up.  Fists clenched.  Eyes open.

    Let’s roll.

    http://theulstermanreport.com/2012/06/28/white-house-insider-obamacare-now-we-are-truly-ready-to-fight/

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  49. berend (1,705 comments) says:

    Psycho Milt: So the resulting compromise mess is his fault because he “failed to get a law through” for a more sensible system?

    Obamacare is unpopular because most people liked the health care they have. And they are afraid, and correctly so, that Obamacare will mean they will lose their employer provided health care. So the people who have care are afraid they will get less. Sort of trying to increase class sizes.

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  50. KiwiGreg (3,249 comments) says:

    “And they are afraid, and correctly so, that Obamacare will mean they will lose their employer provided health care.”

    It’s already starting to happen. For many terminating employer schemes will be cheaper under Obamacare.

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  51. tom hunter (4,732 comments) says:

    Based on Measures of Quality, Efficiency, Access, Equity, and Healthy Lives

    Lies, damned lies and statistics …..

    I’ll look at the link at some point but I suppose it will be the usual stuff focusing on life expectancy and infant mortality. But the latter numbers are unreliable for international comparisons and the former appear to be affected more by basic things such as demographics, clean water and sewerage systems, and diet. Similarly infant mortality rates are five times the national average on Indian reservations (which have publicly financed health care through the Indian Health Service) and quite low in places like Utah and Washington.

    When it comes to things that can actually be linked directly to health care it’s quite a different story – like cancer:

    American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared with 56 percent of women in Europe. For American men, the numbers are even more dramatic. Sixty-six percent of American men live five years past a diagnosis of cancer, but only 47 percent of European men do.

    Of cancers that affect only women, the survival rate for uterine cancer is 5 percentage points higher in the U.S. than the European average, and 14 percent higher for breast cancer. Among cancers that affect only or primarily men, survival rates for prostate cancer are 28 percent higher in the U.S., and for bladder cancer, 15 percent higher.

    And then there are other things:

    The largest international study to date found that the five-year survival rate for all types of cancer among both men and women was higher in the U.S. than in Europe. There is a steeper increase in blood pressure with advancing age in Europe. A 60% higher prevalence of hypertension. The aggressive treatment offered to U.S. cardiac patients apparently improves survival and functioning relative to that of Canadian patients. Fewer health- and disability-related problems occur among U.S. spinal-cord-injury patients than among Canadian and British patients.

    Britain has only one-fourth as many CT scanners per capita as the U.S., and one-third as many MRI scanners. The rate at which the British provide coronary-bypass surgery or angioplasty to heart patients is only one-fourth the U.S. rate, and hip replacements are only two-thirds the U.S. rate. The rate for treating kidney failure (dialysis or transplant) is five times higher in the U.S. for patients between the ages of 45 and 84, and nine times higher for patients 85 years or older.

    Overall, nearly 1.8 million Britons are waiting for hospital or outpatient treatments at any given time. In 2002–2004, dialysis patients waited an average of 16 days for permanent blood-vessel access in the U.S., 20 days in Europe, and 62 days in Canada. In 2000, Norwegian patients waited an average of 133 days for hip replacement, 63 days for cataract surgery, 160 days for a knee replacement, and 46 days for bypass surgery after being approved for treatment. Short waits for cataract surgery produce better outcomes, prompt coronary-artery bypass reduces mortality, and rapid hip replacement reduces disability and death. Studies show that only 5 percent of Americans wait more than four months for surgery, compared with 23 percent of Australians, 26 percent of New Zealanders, 27 percent of Canadians, and 36 percent of Britons.

    There are also weird outcomes, such as the logical conclusion that under a system where one pays, one would skimp on preventative care. However …

    … the proportion of middle-aged Canadian women who have never had a mammogram is twice that of the U.S., and three times as many Canadian women have never had a Pap smear. Fewer than a fifth of Canadian men have ever been tested for prostate-specific antigen, compared with about half of American men. Only one in ten adult Canadians has had a colonoscopy, compared with about a third of adult Americans.

    These differences in screening may partly explain why the mortality rate in Canada is 25 percent higher for breast cancer, 18 percent higher for prostate cancer, and 13 percent higher for colorectal cancer. In addition, while half of all diabetics have high blood pressure, it is controlled in 36 percent of U.S. cases, compared with only 9 percent of cases in Canada.

    I would not get too cocky about the cost aspect either as it’s another apples to oranges comparison between our 80:20 public/private system and their 50:50 system. Our costs are low because, among other things, we suppress the incomes of doctors and nurses – which also means we lose them to places like the USA. That sort of rationing also explains things like the grossly lower numbers of scanners, treatments, surgeries, etc. So yes the cost is lower, but we pay the price in other ways, most of which are probably not measured.

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  52. KiwiGreg (3,249 comments) says:

    “most of which are probably not measured.”

    One of the commonest ways of rationing in a public system is to make you wait. You wait to be seen, you wait to be treated.

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  53. berend (1,705 comments) says:

    tom hunter, on infant mortality the trick is to be counted. I.e. many countries don’t start counting infant deaths until the infant is 72 hours. The best is Cuba: you don’t count until you are 3 months old! Oddly enough the US counts every birth…

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  54. Scott Chris (6,060 comments) says:

    I’ll see your “lies, damned lies and statistics” and raise you a “statistics are like a bikini – what they reveal is suggestive but what they hide is essential”:

    American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared with 56 percent of women in Europe. For American men, the numbers are even more dramatic. Sixty-six percent of American men live five years past a diagnosis of cancer, but only 47 percent of European men do.

    For starters, let’s compare countries with a similar demographic profile and average per capita GDP such as the USA and Canada:

    An assessment by Health Canada found that cancer mortality rates are almost identical in the two countries. [USA and Canada]

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  55. Psycho Milt (2,411 comments) says:

    Obama pretty much wiping his *** on the Constitution.

    Yeah, and who are these “Supreme Court” schmucks to say any different?

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  56. mikenmild (11,247 comments) says:

    Hush Scott, how dare you?

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  57. berend (1,705 comments) says:

    Scott Chris, you’ll need some geographic distance. It’s a bit too easy for a Canadian to get the healthcare he can’t get at home just over the border. And healthcare, if you’re not insured or out of state/country, is actually very affordable. Health tourism is one of the growth industries, competing quite well against the more well-known Asian ones.

    PS: and demographic profile is obviously very different.

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  58. Scott Chris (6,060 comments) says:

    and demographic profile is obviously very different.

    I disagree. Besides ethnic differences the two countries are remarkably similar demographically. See for yourself.

    [The source of the comparison is rather a neat website called NationMaster through which you can pick any two countries and compare them on a wide variety of statistical catagories]

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  59. Weihana (4,496 comments) says:

    berend,

    But why would it? A computer that is far superior than anything in the 70s is so affordable even the poor can afford it (i.e. your phone). If the market is allowed to work, it works, noticed?

    Sure. Competition encourages cost reduction. But is that the be-all and end-all? Not so sure. It appears in the US there is a tendency to delay treatment which tends to exacerbate costs. There also appears to be a relative lack of coordination due to a fragmented system. There is also a considerable administrative overhead that doesn’t exist in a single-payer system. I don’t see that universal coverage necessarily means that all market forces are removed from the industry.

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  60. tas (623 comments) says:

    berend (1,079) Says:
    June 29th, 2012 at 2:23 pm
    Psycho Milt: So the resulting compromise mess is his fault because he “failed to get a law through” for a more sensible system?

    Obamacare is unpopular because most people liked the health care they have. And they are afraid, and correctly so, that Obamacare will mean they will lose their employer provided health care. So the people who have care are afraid they will get less. Sort of trying to increase class sizes.

    I think you have hit the core of the issue. The US has the best medical care in the world, for those that have good insurance. Since most people fall into that category, the majority have more to lose than to gain from Obamacare. Not enough people care about the 1 in 6 who are uninsured.

    And of course americans don’t like the expansion of the government into healthcare. Not that it isn’t over-regulated already…

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  61. Weihana (4,496 comments) says:

    The US is the biggest economy in the world, is at the cutting edge of research and development and has most of the best universities in the world. Of course it has the best. But the way the system works is inefficient. For greatly increased costs the care available appears to be the same or only marginally better and I think that is the core of the issue.

    People seem to want to treat health care as just any ordinary commodity without acknowledging the central role health plays in an individuals life. We can go without many things. We cannot go without our health. Sooner or later we will show up in the emergency room needing treatment and federal law mandates emergency treatment which is likely unrecoverable due to the patients inability to pay. These costs have to be recovered somehow. Someone pays.

    So while many might chastise RRM for perpetuating a myth, are they also willing to undo the federal law that mandates emergency treatment regardless of ability to pay? Surely if health care is just a commodity like any other then people should be allowed to be turned away from the ER for lack of money.

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  62. tom hunter (4,732 comments) says:

    Not to put too fine a point on it, but “Health Canada” are not likely to produce statistics that make them look bad.

    Secondly, given those other stats that show them well behind the US in scanning and testing for cancer, it would be more than a little surprising to find them catching up fast on the treatment side to reach parity in the mortality stakes.

    Finally there is the point that Canada is next door to the US: it’s a well known feature of the Canadian healthcare system that people run across the border as needed.

    besides ethnic differences the two countries are remarkably similar demographically.

    Really?

    The U.S. and Canada differ substantially in their demographics,

    That’s from your first link – which is not to Health Canada but Wikipedia.

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  63. Luc Hansen (4,573 comments) says:

    Given that two major provisions of the bill, that children are covered under their parents insurance until 25 (covering their years in education) and automatic coverage of pre-existing conditions, the decision will give Obama’s camapign a huge fillip as Romney tries to explain why he wants to do away with these measures.

    It should be fun to watch!

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  64. tas (623 comments) says:

    Weihana (1,979) Says:
    June 29th, 2012 at 4:27 pm
    The US is the biggest economy in the world, is at the cutting edge of research and development and has most of the best universities in the world. Of course it has the best. But the way the system works is inefficient. For greatly increased costs the care available appears to be the same or only marginally better and I think that is the core of the issue.

    Hey, I never said US healthcare was significantly better. And, yes, it is woefully inefficient. More to the point, when I said “the core of the issue” I wasn’t referring to inefficiecy, I was referring to why Obamacare is so unpopular (slightly over 50% favour repeal).

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  65. tom hunter (4,732 comments) says:

    It should be fun to watch!

    Children up to the age of 26 were already covered under the SCHIP legislation, as poor people were covered by Medicaid for the last four decades.

    It’s a rather sad commentary on the left that two apparently failed Government healthcare programs are going to be fixed by creating and even larger, more extensive government health care program over the top of them.

    As far Romney is concerned he may not even have any arguments to deal with since most of the Democrats have been reluctant to mention it on the stump. Given that the mandate has now been converted into the largest tax increase on the middle class in decades that should make the stump debates even more fun than you imagine.

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  66. Falafulu Fisi (2,179 comments) says:

    Weihand said…
    Get the republicans on board and then we can have real reform. In the meantime, the individual mandate is a reasonable way to broaden the base to achieve affordable care.

    Do you stand for a philosophy or you just one of those who are confused? Arguing in supporting or opposing from the left to the right end of the political spectrum.

    Unbelievable. One minute you argue against government’s overreaching power. The next minute you worshiped the power of the government.

    Your arguments are all here on Kiwiblog. I can Google them, but I’m sure that you’re aware of what I’m saying here. I can remember all your arguments here in the past, because of your flip-flopping. I don’t take note of others since they stick to what the believe (whether left or right). You is different, because you side with the left on some issues and you side with the right on some issues. You’re all over the place. That’s why I’m asking if you stand for something?

    So, what’s the role of the Government in a free society? Look after the unhealthy? I bet that you believe that it is legitimate role of Government. Do you have an answer?

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  67. Sonny Blount (1,780 comments) says:

    It is absurd to expect the ‘cost’ of healthcare to be directly comparable between the US and other counries. Here are some reasons:

    Different countries are treating different populations of people, the US has 3 times the obesity rate of Sweden, and therefore 3 times the obesity related costs.

    Different services are being performed, the US has the most plastic surgeons in the world by a huge margin, their be 100 times the number in US as in a country like Sweden. So many of the costs in the US system are voluntary and standards are different, British teeth are not acceptable over there.

    Healthcare is one of the top places to spend disposable healthcare. Because the US are wealthier, people are able to spend a higher part of their incomes on healthcare and they do. If you can get a room to yourself and better meals while in hospital, people want this and will pay.

    The US is one of the hotbeds of medical innovation. Because there is a market for $100 a pop pills that may save your life, there is an incentive to innovate and eventually we are able to get those same pills 5 to 10 years later for $10. People pay for these latest and greatest medicines because they would rather be alive and bankrupt than dead with money in the bank.

    The US model is not the free market model. It should be a lot better than it is, but socialism is not the right response to their problems.

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  68. Luc Hansen (4,573 comments) says:

    Children up to the age of 26 were already covered under the SCHIP legislation, as poor people were covered by Medicaid for the last four decades.

    Simply not true in the real world, on both points.

    And now that states have today regained the right to set medicaid eligibilty thresholds, millions of poor will continue to miss out.

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  69. Sonny Blount (1,780 comments) says:

    Scott Chris (4,359) Says:
    June 29th, 2012 at 3:21 pm

    American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared with 56 percent of women in Europe. For American men, the numbers are even more dramatic. Sixty-six percent of American men live five years past a diagnosis of cancer, but only 47 percent of European men do.

    For starters, let’s compare countries with a similar demographic profile and average per capita GDP such as the USA and Canada:

    An assessment by Health Canada found that cancer mortality rates are almost identical in the two countries. [USA and Canada]

    Where do you think Canadians go for their cancer treatments?

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  70. Scott Chris (6,060 comments) says:

    Sonny Blount (1,525) Says:
    June 29th, 2012 at 5:42 pm

    Where do you think Canadians go for their cancer treatments?

    Canada.

    In a Canadian National Population Health Survey of 17,276 Canadian residents, it was reported that only 0.5% sought medical care in the US in the previous year. Of these, less than a quarter had traveled to the U.S. expressly to get that care.

    A 2002 study by Katz, Cardiff, et al., reported the number of Canadians using U.S. services to be “barely detectible relative to the use of care by Canadians at home” and that the results “do not support the widespread perception that Canadian residents seek care extensively in the United States.”

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  71. gump (1,635 comments) says:

    KiwiGreg said:

    I like some of the reporting about “popular” elements of Obamacare – like requiring employers to allow children up to the age of 26 stay on their parent’s plans. Seriously WTF? You’re a child in America if you’re 26???

    —————————-

    Health insurance has become so unaffordable that it isn’t viable for young people or their parents to cover the cost.

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  72. East Wellington Superhero (1,151 comments) says:

    I sometimes forget that 5 of 9 Supreme Court judges are Catholic. All your base are belong to us.

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  73. Sonny Blount (1,780 comments) says:

    Scott Chris (4,361) Says:
    June 29th, 2012 at 6:29 pm
    Sonny Blount (1,525) Says:
    June 29th, 2012 at 5:42 pm

    Where do you think Canadians go for their cancer treatments?

    Canada.

    In a Canadian National Population Health Survey of 17,276 Canadian residents, it was reported that only 0.5% sought medical care in the US in the previous year. Of these, less than a quarter had traveled to the U.S. expressly to get that care.

    A 2002 study by Katz, Cardiff, et al., reported the number of Canadians using U.S. services to be “barely detectible relative to the use of care by Canadians at home” and that the results “do not support the widespread perception that Canadian residents seek care extensively in the United States.”

    0.5% of the population every year is huge Scott. How many Americans go the other way?

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  74. libertyscott (359 comments) says:

    It is worth noting that Obamacare was ACT policy until comparatively recently.

    It bears a lot of resemblance to the model Roger Douglas proposed in Unfinished Business.

    So if the NZ left want to embrace it, then all power to them!

    The biggest problems left untouched are tort reform and the fact that half of all US healthcare is state funded, and it has virtually no real cap on expenditure, unlike state health funding in NZ (or most developed countries).

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  75. Kimble (4,434 comments) says:

    A 2002 study by Katz, Cardiff, et al., reported the number of Canadians using U.S. services to be “barely detectible relative to the use of care by Canadians at home” and that the results “do not support the widespread perception that Canadian residents seek care extensively in the United States.”

    I wonder if the 2002 study by Katz, Cardiff, et al used an appropriate threshold for “care”.

    BTW, 0.125% of Canadians is around 40,000. Around 800 per week.

    There is definitely consumer demand for that product in Canada, a demand that is being stymied by their own government.

    The US model is not the free market model.

    This.

    If that market is free, then the word has lost all meaning.

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  76. Scott Chris (6,060 comments) says:

    0.5% of the population every year is huge Scott. How many Americans go the other way?

    Of which more that 75% of them just happened to get sick whilst in the States. So working with the rough figures based on a Canadian population of 33kk, that works out to be around 100 Canadians per day who visited the states specifically to seek Medical attention. Now what proportion of those hundred would you imagine would be there for cosmetic surgery for instance?

    As for commerce going the other way, apparently Americans spend a billion pa on Canadian prescriptions plus any Americans who happen to get sick whilst in Canada.

    And thirdly, I requote you a passage from the link in my previous post:

    A 2002 study by Katz, Cardiff, et al., reported the number of Canadians using U.S. services to be “barely detectible relative to the use of care by Canadians at home” and that the results “do not support the widespread perception that Canadian residents seek care extensively in the United States.”

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  77. Scott Chris (6,060 comments) says:

    There is definitely consumer demand for that product in Canada, a demand that is being stymied by their own government.

    Plenty of Americans going to Thailand to have their dicks chopped off, or visiting Mexico for alternative cancer treatment.

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  78. tom hunter (4,732 comments) says:

    I was amused by the statement above that millions of people are still going to miss out on getting their Obamacare because of the Supreme’s decision on not allowing Federal coercion of the States, compounding the apparent failures of previous government healthcare programs like SCHIP and Medicaid (and perhaps even Medicare, which is going to be gutted to pay for Obamacare).

    But these programs are not unique in that respect:

    Aneurin Bevan, father of the British National Health Service (NHS), declared, “The essence of a satisfactory health service is that rich and poor are treated alike, that poverty is not a disability and wealth is not advantaged.” More than 30 years after the NHS’s founding, an official task force found little evidence that it had equalized health-care access. Another study, 20 years later, concluded that access had become more unequal in the years between the two studies.

    In Canada, the wealthy and powerful have significantly greater access to medical specialists than do the less well-connected poor. High-profile patients enjoy more frequent services, shorter waiting times, and greater choice of specialists. Moreover, non-elderly, white, low-income Canadians are 22 percent more likely to be in poor health than their U.S. counterparts.

    So programs designed to help the poor – don’t help the poor. It’s just a repeat of what we see in the education sector and the reasons are probably the same:

    In developed countries generally, among people with similar health conditions, high earners use the system more intensely, and use costlier services, than do low earners. It seems likely that the personal characteristics that ensure success in a market economy also enhance success in bureaucratic systems.

    An unsolvable problem perhaps?

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  79. mikenmild (11,247 comments) says:

    Quite true. Any system of social services is likely to be used more by the better educated and more affluent, If we make doctors’ visits free for the under-fives, for example, the take up still will be higher among those who didn’t lack the wherewithal to pay when the visits were charged. It is the old argument between targeting and universal entitlements.

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  80. Luc Hansen (4,573 comments) says:

    Krugman on Obamacare: a sane perspective.

    http://www.nytimes.com/2012/06/29/opinion/the-real-winners.html?_r=1&hp

    So programs designed to help the poor – don’t help the poor.

    That’s not quite the same as what your quote said. The poor are helped, but the middle class help themselves as well.

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