Debate continues on Patient Protection and Affordable Care Act (i.e. 'Obamacare')

The following are more posts in an ongoing debate on Dorfonlaw blog as readers of this blog already know.  jp

Doug has left a new comment on the post "Health Care, Incentives, and Complexity":

JP - The case in Canada you cite is an unfortunate one. The doctors believe that doing another procedure on the patient is not in the patent's best interest. A US hospital was asked to accept the transfer and they denied the request (if they had accepted the Canadian hospital would have transferred the patient). The hospital went to a judicial forum (and the case is proceeding in the courts) much as it would if a US hospital refused to perform a medical procedure because they thought it not in a patent's interest. It has nothing to do with insurance or how the procedure is funded.


Canadians would not unanimously say that US care is better. Some parts of it are the best in the world and some are not that great. The insurance system and costs are in a league of their own (which is why most global insurance policies exclude US coverage).


To say that Obamacare has been found unconstitutional is to ignore the many courts that found it constitutional and is quite misleading (though technically true).


Your point about fraud and waste in government is a non-sequitur. Yes, there is fraud and waste in government but there is also fraud and waste in private insurance. Some of the fraud is against customers (by denying claims that are valid). That there is some waste and fraud in government as in every human organization doesn't mean that government should be abolished (or that no functions should be added to government).
Obamacare is very complex but it is so because of political compromise. The goal was to give everybody access to health coverage and this was the means that could get approval in congress.


You've not responded at all to the real concerns in the post and the article - that the incentives insurers claim are not aligned correctly and the complexity generally serves to deny coverage and drive up costs.


In my case, when I lived in Chicago and had the need to visit an emergency room as I was a bit dehydrated and lightheaded the rather minimal treatment cost me personally about $1000 after a ton of paperwork. This was on top of buying the most expensive insurance option at the place I worked (insurance is supposed to transfer the risk of medical costs - not just push paper).
I do think you've added to the discussion in the past JP,
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Posted by Doug to Dorf on Law at 7:36 AM


And now my (Jp's reply) to "Doug" in blue. Note, my comments may not be verbatim as on dorfonlaw due to attempting to abide by word restrictions there, (which may or may not have been successful):

Doug: JP - The case in Canada you cite is an unfortunate one.... A US hospital was asked to accept the transfer and they denied the request (if they had accepted the Canadian hospital would have transferred the patient).

It's easy to say that the Ontario Health and Science Center would have transferred baby Joseph (when in fact they never really had to prove it); along those lines I'm not so sure that the Canadian hospital wouldn't have in fact refused to transfer Baby Joseph if Priests for Life hadn't insured the hospital's actions would not be "hidden" with the bright light of publicity, (imagine what might happen with parents not so insistent or lacking the wisdom and saavy to contact an organization for help?)  But even if the U.S. Hospital had refused to accept the case, that doesn't change the terrible premise and precedent that life and death decisions could be forced upon a family in what, for all intensive purposes, amounts to rationing of care. (btw the inevitable result of OC also).

D: To say that Obamacare has been found unconstitutional is to ignore the many courts that found it constitutional and is quite misleading...

Again, you miss my point, which is the Administration's hypocrisy. On the one hand, they drop defense of the DOMA after more than 14 years in effect after being declared unconstitutional by merely one Federal District Court, while simultaneously failing to heed the Order of two District Courts as pertains to Obamacare which have expressly pronounced its unconstitutionality in initial challenges.

Moreover, only three federal courts have ruled OC is constitutional. As such, it is more than spin to characterize this close 3-2 split in favor of constitutionality as “many courts have found it constitutional” and my statements to the contrary as “misleading.”

D: Your point about fraud and waste in government is a non-sequitur. Yes, there is fraud and waste in government but there is also fraud and waste in private insurance... [it] doesn't mean that government should be abolished...

Who said anything about abolishing government? Yes, there most certainly is waste and fraud in both government and private companies. My point is the matter of degree, and the most effective means of addressing this state of affairs. Even if true, you only underscore my key points, 1) In light of the extensive corruption and inefficiencies in all things governmental, yours is not an argument for giving the government more control over what you already admit is a wasteful system but less, and, 2) If the government is the one who both regulates as well as establishes the rules for and/or provides this “one size fits all” grand health system, it will inevitably have no incentive to “get it right” when making life and death decisions on behalf of people who will be, in all honesty, just another “number” in the bureaucracy. You thus have ignored the penultimate question I have raised, (i.e., who will regulate the regulators?) At least insurance companies have law suits and stockholders to fear, (after all, companies which are repeatedly sued or fined by regulators go out of business). Government won't even have that incentive under theories of “sovereign immunity.” Thus, common sense dictates against allowing the government to play both the role of provider as well as regulator, (which is akin to asking the Fox to guard the chicken coop!) As I have already stated, any reforms necessary can more effectively be instituted one at a time to better regulate the insurance companies (and gauge the results as you go); OC on the other hand, with its far worse complexity and tendency towards bureaucracy, will result in irrevocably going from the frying pan into the fire.

D: Obamacare is very complex but it is so because of political compromise... You've not responded at all to the real concerns in the post and the article - that the incentives insurers claim are not aligned correctly and the complexity generally serves to deny coverage and drive up costs.

Leaving aside that the only way Democrats could think of reforming health care was to create a monstrous 2700 page bill with multiple new federal agencies and bureaucratic departments to control every health related decision made in America-- the old Russian Politboro would be proud!-- I find your position curiously contradictory. On the one hand you admit that Obamacare is very complex and concede that increasing complexity “drive[s] up costs,” yet on the other hand you insist this behemoth of a bill will lower costs, an untenable position. (It also doesn't address the pressure on the system of increased numbers of doctors and health personnel, which I deal with in previous posts on the ACLP blog, see "What's really the problem with Obamacare?").

Finally, to blame OC's complexity on “political compromise” for a bill rammed through Congress on a straight Democrat party line vote is the height of hypocrisy for those who frequently like to invoke protecting the rights of the “minority.” There may have been “compromise,” but it wasn't with Republicans. Indeed, the fact that such opposition to OC came from within the President's own party should tell you all you need to know. (Then again, coming from the perspective of Senate Dems like Harry Reid for whom the solution is always to expand government and throw other people's money at a problem, regardless of the effect on the problem or the deficit, I am not surprised.) I would hope Obamacare's proponents might honestly admit such flaws in their arguments as herein shown but I won't hold my breath.  jp