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I'm a political junkie.  And I am not sure any decision in our lifetime is going to have wider implication than the ObamaCare hearings before the SCOTUS next week.  Unfortunately, they have decided not to televise the arguments.  But there will be audio.  If any of you find some place that streams them live or posts them later, please post that here. I don't know of any sources for that yet. And if you want to weigh in on the arguments (good or bad) on both sides, this can be a place for that.  Should be a good exercise in objectivity because if you have ever read arguments from things like Roe v. Wade, there were some strong and weaker arguments and responses on both sides.  

I DO NOT want to turn this into another topic on whether you like ObamaCare or not - at least until the arguments are over.  Just on how well the arguments in front of the Court are doing and what you think the different questions and responses from the Court might indicate about which way they lean.  Once the arguments end, the pros and cons of "What now?" can be discussed.

UPDATE: I was able to find both the written transcripts and audio transcripts for the Court.  I assume that is where these will end up.

Tags: ObamaCare, court, healthcare

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My point is to compare totally different genetics of blacks in DC to Cubans in Cuba is apples and oranges when the context is which health care system is the better one.  The more valid comparison is Cubans still in Cuba with those Cubans 90 miles away in Miami.  If the genetics are the same and only location/provider is different, then it is more of an indicator of which system is better - unless you want to say that the further north you live the healthier you are or something.

And do you read the improvements amongst Cubans in CUBA  across 3 decades of socialised medicine as significant at all?

Seriously, no.  Improvement doesn't equate to quality.  A new book that has the highest percentage of change on the charts doesn't indicate that it's an excellent book.  If it had zero sales last week and 10 this week and 100 next week, a ten-fold increase doesn't really mean a whole lot because the selling of 100 books doesn't indicate quality.  The reality is that it is a lot easier for "backward" countries to catch up to "advanced" countries once the technology is developed.  So the level of speed in which someone can advance once someone else has blazed the trail doesn't mean that the follower is somehow better than the leader.

Jax Agnesson said:

And do you read the improvements amongst Cubans in CUBA  across 3 decades of socialised medicine as significant at all?

I'm fascinated (and a bit shocked) by the vehemence of your 'competitive comparison' take on this question, Daniel. As I have made clear, my point was simply to use the example of Cuba to show that socialised medicine is not necessarily a disaster, as Frank seemed to imply it was.

I was using the yardstick of US progress in medical health, (as without question one of the most technically advanced and wealthy nations in the world) not to show that the US system is somehow 'worse' than the Cuban one, but simply because some yardstick is necessary to put Cuba's progress in context, and the most advanced Western nation provides surely a very good yardstick for comparison. Also, incidentally, these data are robust and readily available.

The fact that Cuba has managed to make considerable improvements in the health of its population, in spite of embargoes etc, can hardly be denied, can it?



Daniel said:

Seriously, no.  Improvement doesn't equate to quality.  A new book that has the highest percentage of change on the charts doesn't indicate that it's an excellent book.

This is a false analogy. The quality of a book can not be inferred from its sales figures, of course. But the effectiveness of a Health Service can be inferred very directly from reductions in mortality rates. In fact it's hard to imagine a more appropriate metric.

I'm not denying that they have made improvements.  And I'm definitely not angry or "vehement" in any way over this.  The context as I saw it was two-fold.  (1) Is socialized medicine better, and (2) Do faster advances indicate that it isn't a disaster.  To me, the answer to both questions is that neither view of the data gives a a "yes" answer.    The fact that it is better than it was doesn't mean it's good. It was just a worse disaster at one time than it is now.  But I can say that because "disaster" is one of those subjective terms based on a comparison to something else.  And when it comes to healthcare, I think our standard of care here is the gold standard and Cuba's doesn't really come close.  But your definition of "disaster" may be different.  Compared to some place in Africa, I'm sure Cuba's level of care looks heavenly.  But, to me, the context was their care versus ours. 

Jax Agnesson said:

I'm fascinated (and a bit shocked) by the vehemence of your 'competitive comparison' take on this question, Daniel. As I have made clear, my point was simply to use the example of Cuba to show that socialised medicine is not necessarily a disaster, as Frank seemed to imply it was.

I was using the yardstick of US progress in medical health, (as without question one of the most technically advanced and wealthy nations in the world) not to show that the US system is somehow 'worse' than the Cuban one, but simply because some yardstick is necessary to put Cuba's progress in context, and the most advanced Western nation provides surely a very good yardstick for comparison. Also, incidentally, these data are robust and readily available.

The fact that Cuba has managed to make considerable improvements in the health of its population, in spite of embargoes etc, can hardly be denied, can it?

Are we going to compare mortality rates, like those of Cubans versus Cuban Americans, or are we going to compare the rate of improvement in mortality rates?  The idea that "effectiveness" can be measured by "advancement" baffles me.  Someone who goes from a score of 65 on a math test to 85 increases their score by roughly 30%.  But the person who goes from 92 to 97 doesn't.  Doesn't make the person with a 97 dumber or the person with an 85 a better student.  The context of your mention of Cuba was "that some very narrow band of basic material needs may even be more efficiently produced by collective organisation that by private enterprise".  Just how does the fact that Cubans die more in Cuba than in America show that they are "even more efficient than private enterprise"?

Jax Agnesson said:

Daniel said:

Seriously, no.  Improvement doesn't equate to quality.  A new book that has the highest percentage of change on the charts doesn't indicate that it's an excellent book.

This is a false analogy. The quality of a book can not be inferred from its sales figures, of course. But the effectiveness of a Health Service can be inferred very directly from reductions in mortality rates. In fact it's hard to imagine a more appropriate metric.

I guess we could compare Cuba with its Health service to Cuba before its health service? That would eliminate your concerns about genetic factors, and would equalize out any environmetal factors like swampland vs forest, town vs country, etc. But then we'd have the issue of scientific and technical changes across half a century to worry about. Plus, as you point out,  developments in health education are of vital significance, as are education in basic hygiene, nutrition etc.

Or we could compare Cuba with other nearby carribean and central American states that don't have socialised health care. This would allow us to compare countries across the same time scale, as we have done with the US/Cuba stats, but would eliminate diferences in wealth and technological capacity. This would show socialised medicine in a much more favourable light. (Check out Dominican Republic etc)

You say Cuba's health system is better in the sense that it used to be a 'worse disaster than it is now'. By that metric, you're describing the US current score for perinatal deaths per thousand live births,  (which is numerically equal to Cuba's across the last few years of the chart,) as a disaster?

Anyway, we could go on wrangling interpretation of statistics till the cows come home. But since you agree with my original point, which was simply that socialised medicine isn't necessarily a disaster, I think we can leave it there?

There are a LOT of factors related to health.  Who runs your health service is a minor one.  Genetics and education are a much larger factor.  That is why comparing Cubans in Havana to blacks in Washington DC doesn't make a whole lot of sense.  Different cultures, different genetics, different diets, and other differences all come into play.  In 8 years, DC infant mortality rates went from 16.1/k to 10.9/k.  Based on your numbers Cuba went from roughly 19/k to 14/k.  I'm just not sure how that shows that their system is more efficient that what DC did in the same time period under non-socialize medicine.  If anything, it shows that perhaps it isn't best to have the government run medicine, but best if they encourage things like education and visiting care givers.  But it gets even worse for places like Cuba when you actually compare apples to apples.  The following is from here:

The primary reason Cuba has a lower infant mortality rate than the United States is that the United States is a world leader in an odd category — the percentage of infants who die on their birthday. In any given year in the United States anywhere from 30-40 percent of infants die before they are even a day old.

Why? Because the United States also easily has the most intensive system of
emergency intervention to keep low birth weight and premature infants alive
in the world. The United States is, for example, one of only a handful countries that keeps detailed statistics on early fetal mortality — the survival rate of infants who are born as early as the 20th week of gestation.

How does this skew the statistics? Because in the United States if an infant is born weighing only 400 grams and not breathing, a doctor will likely spend lot of time and money trying to revive that infant. If the infant does not survive — and the mortality rate for such infants is in excess of 50 percent — that sequence of events will be recorded as a live birth and then a death.

In many countries, however, (including many European countries) such severe medical intervention would not be attempted and, moreover, regardless of whether or not it was, this would be recorded as a fetal death rather than a live birth. That unfortunate infant would never show up in infant mortality statistics.

That being said, we are three pages into a discussion of something that we won't even be able to comment on until Monday. I was trying to avoid the whole "is government care better than private care" or "is socialism Christian" or anything like that.  Just as liberals and conservatives can look at the same event (like the budget surplus of the Clinton administration) and disagree over whose policies were responsible, arguments over "should we or shouldn't we" when it comes to government healthcare are debates that will never be solved.  That is why I was trying to keep this topic limited to an objective discussion of the arguments.  If we can forget, for a moment, who we think is right and which side is wrong and just concentrate on the strength of the argument, I think it would be a good exercise in objectivity.  That was my goal.  And I'm not helping my goal by getting into a debate between Brits.  So I think I'll just bow out of that.

Overnight, I read/listened to the arguments in front of the 11th Circuit Appeals Court on this case.  It's a very cool web site and even has associated iOS and Android apps for it.  I found the government's strongest argument had to do with cost-shifting and the amount of "commerce" associated with others having to pick up the bill for the uninsured deadbeats.  But the strongest case for the states/individuals was that if you want to regulate how deadbeats who can't pay should be forced to sign up for insurance right then, that is fine.  But you can't call it regulation of commerce to force the guy sitting at home not getting hospital care to purchase something when he is not actively participating in commerce.  The 11th circuit found that the individual mandate was unconstitutional.  But I could see how the SCOTUS might find otherwise if the argument is presented stronger that the Filburn case or Raich case should apply as precedent.  

In the first, it was found (back in 1942) that individual conduct in one's own yard could effect interstate commerce (prices) if everyone did it.  So, under that logic, if no one purchased insurance, there would be a huge impact therefor the government should be able to force you to do so.  In the second more recent case, it had to do with the national right to regulate marijuana even if it is a "local" matter.  Local production and consumption effected the national market.  The flip side of the argument that is going to have to be made is that in both of those cases, the government was STOPPING activity.  It has the power to regulate activity.  But it can't FORCE an commercial activity from an immobile person by coercion.  It is one thing to say that you can't grow it (pot or wheat) yourself but must buy it in the marketplace and saying to someone that doesn't want it (no matter what it is) that you must become an active participant in X commerce.  This mandate is unprecedented because it forces commerce and, if it stands, then Congress can force you to purchase whatever it wants.  Instead of giving you a break if you purchase a house or Chevy Volt or whatever with incentives, they can force you to do so and penalize you if you don't.

One of the judges questions though was really good.  She asked the government's lawyer about the ramifications of not buying insurance.  They can penalize you with a fine, but there are no levies, no liens, an no interest applied to it.  So she asked how is that any different from a bill from the hospital that you won't pay.  If there is no more incentive to pay the bill, what does it really solve? Had to laugh at that one. LOL

Today's arguments are now over.  It was probably the most boring of the three days, as far as the topic being covered, but may be the most important.  If SCOTUS finds that no one has standing to oppose ObamaCare until after they have been penalized for not taking part, this whole thing can get kicked down the road until after April 2015.  In effect, this would be a win for the administration because, by then, it would have all been put into place already and NO politician wants to be seen as taking away benefits from some person once they have been granted.

If I was the other side, I'd argue that costs are already being incurred (by the states and healthcare companies).  We'll see though.  Transcript and audio should be released in a couple of hours.

Been playing around with some numbers just so we can see what we are talking about.  This is our current situation.

And this is how the "uninsured" wedge breaks down.

Now here is the interesting thing about these numbers.  Starting at the top and moving clockwise, the 14% are insured and don't know it.  The 9.4% would be auto-enrolled and eligible for Medicaid should they go to a provider for service. So, even though they are not currently enrolled, they are covered.  The 20.4% non-citizens would not be covered under ObamaCare anyway (or so we are told).  A lot of the 10.9% of childless couples are young and healthy and don't WANT insurance.  The 22.1% that make three times the poverty amount ($62K for a family of 4) have the money to buy insurance if they want, but choose to NOT get it.  So basically what you end up with is this:

91.4% are insured or ineligible.  5% don't want it.  3.5% are "other".  So the plan is to make the 5% purchase insurance, stick most of that 3.5% into Medicare by expanding who is eligible, and that is going to make our whole system a lot cheaper.  Does that about wrap it up?

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