Thursday, June 28, 2012

Short Thought on Today's Obamacare Ruling

Today was a fun day to be a law nerd.

The Korean has said this from Day 1 of this dreadful litigation:  if Obamacare was structured as a single-payer public insurance program, complemented by private insurance companies like the majority of advanced nations, ALL this could have been avoided. There would have been no individual mandate, and no constitutionality issue since it would have been exactly like Social Security or Medicare.

Wanna see a successful single-payer system that creates very little administrative delay and a $5 doctor visit? Here is an old post about Korea's healthcare system.

Got a question or a comment about the Korean? Email away at


  1. I was opening that court would strike it down, so that Congress would pay such a thing.

  2. Korean,

    Single payer system? The American health care insurance companies would NEVER allow that to happen! :) Seriously, there's just too much money in health care right now. There's an entire financial economy that has developed in the U.S. around private health care/insurance companies, one that makes lots of money and has tons of political power. As one American doctor once told me, "Do you think I work for the hospital? I don't work for the hospital. I work for the insurance companies!"

    Thanks for the writeup on the Korean system.

    1. Most doctors work for themselves. They have private practices. They just use a hospital for the equipment and nurses. They have enough skills and education to not require a hospital based practice. Those who do work for the hospital like Kaiser or as hospitalists are usually risk averse and lazier than the private practice. Canada doctors regularly fulfill their quota of patients before the year is over, then relocate to the USA for private practice to earn more money. This indicates that doctors with quotas like in Kaiser, Canada or hospitalists don't work as hard because they won't be getting any additional return on their additional effort.

      You should listen to the Planet Money podcast on NPR about how doctors have a huge say in the reimbursement system regarding insurance. Often they dictate and allow unreasonable charges.

    2. Insurance companies make deals with companies to sell their healthcare plan. So Instead of many companies, the insurance companies would bid to the government to represent the government healthcare plan. The basic plan would be like what the employees get now at a big company like Apple, GOOGLE, or other. The insurance companies can see premium plans at an extra cost. So instead of having a big sales team to bid on insurance to companies, you could have a small sales team that would work with the government.

    3. I don't dispute that insurance companies make deals with large customers, I was noting that your doctor friend is not working for the insurance company. Doctors do have a say, my father (a doctor) is part of a rate setting committee created by the largest insurance company in the State. He has influence and a voice to negotiate the rate of reimbursement and other structures. Planet Money showed that the AMA recommends DRG codes and reimbursement which are mostly approved by CMS unchanged. It is doctors who fail to involve themselves in the business side of their profession who feel left out and puzzled.

      Doctors should be smart enough to handle both the medical and business aspects of their industry.

  3. TK and kuiwon, you're living in a fantasy world. Single-payer was not going to make it through at the Federal level.

    The ACA was/is necessary to lay the foundation for a system of national coverage. We need to get that working and then, if it is needed, push it toward something like Medicare for all.

    And it is not a dreadful piece of legislation. Though imperfect, it does a lot of things that need to be done, and it's a reflection of out political reality where so many Americans believe the private sector ( which autocorrect just now changed to "Ravage sector") is always the preferred method over government bureaucracy. I don't agree, but I recognize that trying that is the first step toward a more ideal system.

    Now the various states are free to experiment, and one or more of them may decide to go with a single-payer that is a model for other states, but without the ACA we would be where we were since the last time national health care was seriously proposed.

    1. The ideal system is where everyone pays for their own health care services. Anything other than that is less than ideal. Idealism often cannot be achieved in the world we live in, but it gives us a goal to measure by.

      Health care should not be a right since it is a service provided by other individual people. When you compel others to serve, that is closer to slavery than liberty. The USA does not draft soldiers any longer since the people wanted more liberty. You advocate for people to provide for others. I refuse to provide for the drug dealer, drug abuser, alcoholic, my enemies and people who made avoidable and terrible decisions in their life. Why are you asking me to help them? Will they contribute to the US society in a net positive way? Can we impose some behavior requirements on them? Can we make them eat as a vegetarian? They impose their need on my wallet and the nation's debt, yet I don't see any reciprocity.

  4. kushibo,

    TK is only saying that the litigation was dreadful.

  5. Korean healthcare rocks.

    The bigger fish is the ridiculous regulation involved in healthcare, which is proportional to the high cost. Whether paid by state or citizens, cost rises if more paperwork is pushed through the loop.

  6. The only ethical system is where people pay for their own health care services.
    It is when people don't have money to pay for their consumption of services that problems happen. People who take money from others ought to be grateful, feel shame and strive with all their effort and life to become rich enough to be self sufficient. This means no junk food, no narcotics, no alcohol, working at least 2 jobs to make money and not commit any crimes or having sex and babies when they can't take care of themselves.

    Too many in the USA don't feel shame, gratefulness, desire to work harder and avoid pregnancy or addiction. People should not only look for jobs, they should strive to become business owners. Americans should not be a nation of workers, it should be a nation of entrepreneurs. Workers can only follow and not innovate for the good of society. Nobody will remember the engineers who made the iPod, but everyone will remember Steve Jobs the entrepreneur.

    There should not be an expectation of the same level of care between the private paying customer and the public assistance customer. Public assistance should only meet minimal amounts of care since it is money sucked out of others hands. If the government wants to prove it can deliver a better system, they should make a parallel system like we have for schools. Then we can compare and see who truly is better.

    1. The only ethical system is where people pay for their own health care services.

      What's so ethical about allowing people who don't have money to die on the streets like animals?

      Bad health is not simply the result of pregnancy, addiction, or other poor life choices. Bad health is an inevitability -- sooner or later, especially when you are old, you will be ill. Everyone will be ill. That's why it is important to address the issue at the national level.

    2. Health care service is not provided by Nature or by your own efforts. Compensation must to be given to those who provide service (assuming it isn't charity like Shriners). It is not correct to force a 2nd party to pay for that service. Ethically, you should pay for your consumption. How can you confuse this with letting people die in the street?

      It is not correct and ethical to make me pay for your lunch. Even if you are poor and starving, I should be given the choice to help you or let you fend for yourself. Everyone will be hungry, but you cannot say it is ethical to steal my money for your benefit. Just because a republican style government is given the authority to make these policies, doesn't make it correct or ethical. Government policies are often dumb and wrong.

      As I said in my post, problems arise when people are poor. What to do with those? Do we allow them to suffer or die in the streets? What if we let them stay in a room to die in so they can maintain a veneer of dignity? Do you want me and others to give 2.1 million dollars for services? How far away do we stray from the only ethical policy of self sufficiency? I assume you think ethics mean people should help the less prosperous. But it is in conflict with the ethics of property and liberty. As an American, I feel liberty trumps forced aid. Especially when that transfer or resources goes to individuals rather than communities.

      I love public libraries, roads, fire departments, police, our military, our court system and hundreds of other public services. I love them because they service the public, not an individual only. I can enjoy the benefit of my tax money. The fire dept puts out the fire from a single house, but it protects my neighborhood. It also protects my city when wildfires burn. The police attempt to reduce crime and inflict punishment on criminals, so I can feel safer. What societal gain do we get when we pay for the health care of the drug dealer, the drug abuser, or people too lazy, arrogant or uncooperative to get a job? I believe society usually incurs a net loss in terms of economics and quality of society.

      When given other people's money, the recipient and recipient's family/friends, do not behave in a manner which I find proper. They should be grateful, hard working, humble, avoid bad judgement and feel some shame. Koreans feel shame for things they don't have any relation with, but it is a powerful emotion that allows them to achieve.

      Finally, WSJ has an article about the idiocy of public funding of other people health care. Please read it.
      An example of tremendous public support for a loser woman with 15(!) children and not an ounce of gratitude, effort and shame.

    3. Ethically, you should pay for your consumption. How can you confuse this with letting people die in the street?

      Because if you forced everyone to only receive healthcare for which they can pay and not a scintilla more, people will die in the street. It is a natural consequence of choosing a certain policy.

      I assume you think ethics mean people should help the less prosperous. But it is in conflict with the ethics of property and liberty. As an American, I feel liberty trumps forced aid.

      Declaration of Independence, the document that expresses the American ideal, places "life" ahead of "liberty". Availability of healthcare saves lives.

      I love public libraries, roads, fire departments, police, our military, our court system and hundreds of other public services. . . . What societal gain do we get when we pay for the health care of the drug dealer, the drug abuser, or people too lazy, arrogant or uncooperative to get a job?

      By your logic, what societal gain do we get when we allow drug dealers/abusers, lazy people, etc. to use public libraries, roads, fire departments, police, etc.? And you fail to address my point that poor health is not exclusively a result of drugs or laziness. Vast majority of people who are in poor health are hard working, humble, avoid bad judgment, etc. Let me reiterate: bad health is an inevitability -- sooner or later, especially when you are old, you will be ill. Everyone will be ill at some point in their lives. Even if everyone in America was drug-free and hard-working, America will still need healthcare.

    4. Ethics says a person should pay for their own consumption. Ethics also says we should help our fellow man to a reasonable extent. They are not mutually exclusive. My argument is that ethical behavior is to pay for your own consumption. You are arguing that my statement is not ethical.

      If you ate a bowl of BiBimBap, should I pay for it? I think the Korean should pay for his own food. If the Korean is poor, that doesn't negate the ethics that he should pay for his dinner. The Korean should always pay for his consumption, he just isn't able to. You confuse what should be done with what can be done.

      I don't object to charity, to helping others. I want to help people. I do help people through my voluntary community service, my voluntary charitable donations and unfortunately, through my contributions to Medicaid and welfare.

      You mistakenly say I force people to only receive what they can pay for. There is no forcing of any sort in my argument. I am arguing that ethics state people should pay for themselves. Am I forcing you to forgo the ribeye steak with caviar and white truffles because you can't afford it? You make the same mistake as the US government saying that inaction is action. You are the one advocating force. You want to force people to give at the point of a gun I might add. I am advocating to reduce force and to allow liberty of choice. I don't object to people giving health care as a charity like Shriners or most hospitals and doctors.

      You assume that life before liberty in the Declaration is a statement of priority. Maybe it was just better sounding. There has not been any evidence that Life is prioritized higher than Liberty in the Declaration. Your argument that life is prioritized higher than liberty is wrong. Anyways, the Declaration states that we are endowed with the right to Life, Liberty and Pursuit of Happiness. This means we are born with Life and others don't have a right to take it away. You confuse this point with the right to life with other people's money. The Declaration doesn't ask people to give others life or save others life, it actually supports my argument that liberty trumps helping others.

      Society loses out when those drug dealers use public goods. However, society has a net gain from those goods since all the public can enjoy it. Society loses when drug abusers and lazy losers take our welfare money since they are a net drain on society and we just increase the drain. The money given to them does not see society get richer.

      The vast majority may not be bad people and they may act in the proper manner (I have yet to see this), but that doesn't mean they shouldn't be paying for their health care. I mostly see lazy, ungrateful people using welfare and Medicaid. I participated in a homeless feeding service, only 1 out of 100 people came up to me to thank me. Most of them sullenly took their food, ate it and then just hung around the park for hours. I put money and effort into cooking, planning, transporting and serving the food. If these people put in equivalent effort to get a job, they could work at McDonalds or Costco rounding up shopping carts.

      Finally, you say health care is inevitable, but that doesn't have relevance to my issue. You just added that in. I don't deny it is inevitable, I think if the federal government wants to address it, it should create a parallel system to show how good or bad it can do it. Just like public school versus private school.

    5. TNcare almost bankrupt my state. Tennessee pays about 10 billion into the system and it covers about 1.2 million poor people. So the TNcare cost is about $8,333.43 per person of the 1.2 million people on TNcare.

      About 5 years ago TNcare's administration costs was over 60% and it payed a U.S. Senator 34 million for consulting. Also many doctors refused to accept TNcare because the payouts were so small.

    6. I believe the any government system would be less efficient, more costly and result in less patient care than a pure private system. I just want to the pro-public system advocates to go full bore on their position, see how stupid and terrible it is, and kill the debate forever.

      Just like the universal preventive medicine idiots. It will end up costing more than current because everyone will participate in the preventive treatments/tests. Any predicted reduction in late term treatment will not be offset by the massive volume of preventive treatments. I believe late term treatment will also go up because more people will be tested, finding more illness and then those people who would have died are now trying to get cured, driving up cost.

    7. If you ate a bowl of BiBimBap, should I pay for it?

      If you cannot make the simple distinction between an option and a necessity (without which death results,) I really do not see the point of continuing on with this conversation. Keep frothing.

    8. This comment has been removed by the author.

    9. If it is such a necessity, why are many groups exempt from being on Obama care?

    10. Eating is a life saving necessity, why do you think it is not? You fail to address the ethics issue which is my main point. People should pay for all their own consumption. IF they cannot, then they OWE the service provider. That doesn't mean others should be prevented from paying, the poor person should remember that they still owe a debt.

      Many medical treatments are not life saving.

  7. I do agree that it should be a single-payer with the same rate for everyone. I also would like to see the companies pay their part per employee into the single-payer system as they would for their private health insurance. The companies may pay about 1 to 2% more to cover the people that will be exempt from paying. By having this single-payer system, we could eliminate the VA hospital, medicare, and other government healthcare.

    Instead of paying to the insurance company you would be paying the government health people. So we could base the plan from a big company like IBM, Apple, or other. Find out what their employee rate and that would be the standard rate for the single-payer plan.

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