Obamacare Supreme Court Decision

[noflag]

Could someone explain what the the new ruling implies for future physicians applying to medical school in the coming years?

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[nwts]

Kind of off topic, but it would probably be best to get into the habit of referring to it as the Affordable Care Act. I think medical school interviewers generally don't appreciate people calling it Obamacare. You probably want to get into the habit of calling it the Affordable Care Act now so that you don't slip up in an interview.

 

[mimelim]

Kind of off topic, but it would probably be best to get into the habit of referring to it as the Affordable Care Act. I think medical school interviewers generally don't appreciate people calling it Obamacare. You probably want to get into the habit of calling it the Affordable Care Act now so that you don't slip up in an interview.

I don't think that people care as much as you think. I was at a conference last week and one of the senior authors in the Obama administration that wrote it kept referring to it as Obama Care, while the VP from Blue Cross kept saying ACA. Never mind that most physicians around here refer to it as Obamacare.

 

[deleted480308]

I don't think that people care as much as you think. I was at a conference last week and one of the senior authors in the Obama administration that wrote it kept referring to it as Obama Care, while the VP from Blue Cross kept saying ACA. Never mind that most physicians around here refer to it as Obamacare.

and it's only the ACA in verbal reference because it's not as popular as Obama had hoped......if it had 99% approval ratings, he'd have a face tatto that said, "I'm the obamacare guy"

 

[mimelim]

and it's only the ACA in verbal reference because it's not as popular as Obama had hoped......if it had 99% approval ratings, he'd have a face tatto that said, "I'm the obamacare guy"

I live in a very Red state. It is immensely popular. People may not say it because of their political affiliations/leanings, but the number of people impacted by it directly or have family that have been significantly impacted by it is quite substantial and will only grow. Don't get me wrong, I will make less money over my career secondary to all of these changes and will see more patients. But, from a population standpoint, this helps increase access, which will be popular over time. You generally just don't hear the lower class voice early on .

 

[deleted480308]

It is immensely popular.

Nope... http://www.realclearpolitics.com/epolls/other/obama_and_democrats_health_care_plan-1130.html

 

[mimelim]

Nope... http://www.realclearpolitics.com/epolls/other/obama_and_democrats_health_care_plan-1130.html

"Public approval of health care law" is not the same as a program being popular or continuing to grow.

 

[deleted480308]

"Public approval of health care law" is not the same as a program being popular or continuing to grow.

public approval is absolutely the same as popularity

enrollment continuing to grow can't be used as a sign of popularity when you fine people for not enrolling

 

[nRomaleos]

public approval is absolutely the same as popularity
enrollment continuing to grow can't be used as a sign of popularity when you fine people for not enrolling

Then surely the republicans will capture the general election because it is so unpopular!

 

[deleted480308]

Then surely the republicans will capture the general election because it is so unpopular!

surely you are aware that it's not the only thing going on in the country?

 

[nRomaleos]

surely you are aware that it's not the only thing going on in the country?

i yoke i yoke

 

[chemist16]

and it's only the ACA in verbal reference because it's not as popular as Obama had hoped......if it had 99% approval ratings, he'd have a face tatto that said, "I'm the obamacare guy"

I think that if you spearheaded Obama's campaign like that - "If I achieve 99% approval ratings, I will tattoo my face with "I'm the ObamaCare guy!" - the people would repeal the 22nd Amendment and re-elect him president.

 

[Easonred57]

I live in a very Red state. It is immensely popular. People may not say it because of their political affiliations/leanings, but the number of people impacted by it directly or have family that have been significantly impacted by it is quite substantial and will only grow. Don't get me wrong, I will make less money over my career secondary to all of these changes and will see more patients. But, from a population standpoint, this helps increase access, which will be popular over time. You generally just don't hear the lower class voice early on .

Agreed. Even my staunchly republican, Obama-hating grandparents who balked at the ACA now admit that they love their Obamacare.

 

[emraldragon]

Agreed. Even my staunchly republican, Obama-hating grandparents who balked at the ACA now admit that they love their Obamacare.

They're on Obamacare? Not medicare?

 

[Easonred57]

They're on Obamacare? Not medicare?

According to them. I try not to open it up too much for discussion. I could be wrong, but doesn't Obamacare support Medicare in some ways?

 

[deleted600623]

I'm all for people having access to healthcare that truly can't afford it. But increasing taxes on those who can barely afford to pay for their own private insurance to pay for someone else? Do we really want to be like Europe when it comes to healthcare? I didn't think so.

 

[deleted480308]

I'm all for people having access to healthcare that truly can't afford it. But increasing taxes on those who can barely afford to pay for their own private insurance to pay for someone else? Do we really want to be like Europe when it comes to healthcare? I didn't think so.

People can't have stuff they can't afford unless someone else pays....your ideals are in conflict

 

[NorthOfBroad]

only in america do we consider it a victory that people cannot be excluded from paying for health insurance because of a pre-existing condition

 

[deleted600623]

So you tax the middle class to pay for the lower class then what? Middle class can't afford their insurance so they have to be on obamacare instead of private. It is 100% socialism and it doesn't work. Just look at how mediocre Europe's everything is...

 

[emraldragon]

According to them. I try not to open it up too much for discussion. I could be wrong, but doesn't Obamacare support Medicare in some ways?

That's kind of why I was asking. My Grandma has been pitching a fit about Obamacare for some time and can't wait to see entitlements like that repealed. She says its negatively affecting her medicare--which you can pry from her cold dead fingers because that's the only way she's giving it up. I don't completely understand that aspect and Grandma certainly isn't the voice of reason on this one . . .

 

[nwts]

I don't think that people care as much as you think. I was at a conference last week and one of the senior authors in the Obama administration that wrote it kept referring to it as Obama Care, while the VP from Blue Cross kept saying ACA. Never mind that most physicians around here refer to it as Obamacare.

Interesting. I still think it's best to be safe and call it the Affordable Care Act, though. I view "Obamacare" as being a slang term, and I try not to use slang in interviews for anything. I feel like using slang in interviews is just too casual, and some view it as unprofessional. Many interviewers might not care, but I feel like there are at least some who would prefer that you don't.

 

[nRomaleos]

That's kind of why I was asking. My Grandma has been pitching a fit about Obamacare for some time and can't wait to see entitlements like that repealed. She says its negatively affecting her medicare--which you can pry from her cold dead fingers because that's the only way she's giving it up. I don't completely understand that aspect and Grandma certainly isn't the voice of reason on this one . . .

The entitlements in Medicare and ACA go hand-in-hand.

ACA supports Medicare by closing the Part D "Donut Hole." 5 years ago your grandmother had to pay out of pocket for significant portions of medications that were not covered by Medicare. Today, her entitlements can afford to cover a larger % of the costs.

I'm all for people having access to healthcare that truly can't afford it. But increasing taxes on those who can barely afford to pay for their own private insurance to pay for someone else? Do we really want to be like Europe when it comes to healthcare? I didn't think so.

You mean increasing taxes on those who make over six digits? And businesses with 50+ employees?You already pay for someone else when you buy insurance of any kind.

ACA is an average piece of policy at best. However, it has curbed the rate at which premiums have gone up in the last year and a half. And that is about as much as we can ask for in the current state of US politics.

 

[emraldragon]

Medicare is an entitlement. Obamacare is NOT an entitlement.

But ACA does support medicare by closing the Part D "Donut Hole." 5 years ago your grandmother had to pay out of pocket for significant portions of medications that were not covered by Medicare. Today, her entitlements can afford to cover a larger % of the costs.

Thank you for your explanation about the donut hole. The above was supposed to be completely baffling because it truly does not make sense. I was taking a little dig at my grandmother (for which I will call and apologize to her) and anyone else who says things like "No gov't subsidies for ppl who need help paying for healthcare!!! But don't take my medicare even though I never worked a day in my life and have far exceeded what I would have paid into it even if I had!!!"

It's moments like these where I truly appreciate @sb247 and his opinions. I may disagree with most of them but he is well-informed and consistent.

 

[emraldragon]

So you tax the middle class to pay for the lower class then what? Middle class can't afford their insurance so they have to be on obamacare instead of private. It is 100% socialism and it doesn't work. Just look at how mediocre Europe's everything is...

I'm not sure what you mean when you ask us to look at how mediocre "Europe's everything is"? Were you referring to their healthcare? Education? Economy?

I let my fingers do the walking and googled just the healthcare aspect and found a few sources. They all had differences, but they all agreed that several European nations (and some non European) were providing better healthcare than the US. They had different metrics, so I'm not sure what metrics you were citing. Here are the sites I located . . .
http://thepatientfactor.com/canadia...zations-ranking-of-the-worlds-health-systems/
http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror
http://www.bloomberg.com/visual-data/best-and-worst//most-efficient-health-care-2014-countries

I do apologize for being unable to find consistent websites without political leanings.

Finally, just a quick question: Does the Georgia in your name signify the one in Europe or the one in the US? I'm asking because I don't want to assume the wrong way.

 

[deleted480308]

Thank you for your explanation about the donut hole. The above was supposed to be completely baffling because it truly does not make sense. I was taking a little dig at my grandmother (for which I will call and apologize to her) and anyone else who says things like "No gov't subsidies for ppl who need help paying for healthcare!!! But don't take my medicare even though I never worked a day in my life and have far exceeded what I would have paid into it even if I had!!!"

It's moments like these where I truly appreciate @sb247 and his opinions. I may disagree with most of them but he is well-informed and consistent.

huzzah! I'm like a novelty or a cartoon around here, but I try to be a principled one

 

[Goro]

Are they the same people who protested with signs that said "Keep your gov't hands off my Medicare?"

Agreed. Even my staunchly republican, Obama-hating grandparents who balked at the ACA now admit that they love their Obamacare.

FYI, my sister, lives in OH and is disabled from a work injury, is on Medicare thanks to the ACA in the Buckeye state. I'm a Yellow Dog democrat., but I have a lot more respect for Gov Kasich now, unlike the current residents of the Republican candidate's clown car.

 

[MTGPGE]

Does this ruling close the coverage gap or just maintain the status quo?

 

[nRomaleos]

Does this ruling close the coverage gap or just maintain the status quo?

Status Quo.

It verified the constitutionality of using taxes to fund ACA's health insurance subsidies a.k.a the lifeblood of Obamacare

 

[cherubb3]

The uninsured % in my ER went from 25 to 5 in a span of six months because of Obamacare.

 

[deleted480308]

Status Quo.

It verified the constitutionality of using taxes to fund ACA's health insurance subsidies a.k.a the lifeblood of Obamacare

still status quo, but slightly more focused than that....it verified that people buying on the federal exchanges (from states that didn't set up state exchanges) could still get the tax credit. The language of the law was "exchanges run by the state" and that was conflict

 

[MTGPGE]

still status quo, but slightly more focused than that....it verified that people buying on the federal exchanges (from states that didn't set up state exchanges) could still get the tax credit. The language of the law was "exchanges run by the state" and that was conflict

That's what was unclear to me, since none of the articles I read about the decision even mentioned the coverage gap. I support the ACA, but I think it's disingenuous for the Obama administration to proudly declare that it's here to stay without acknowledging that 3.7 million people in the US are still uninsured, including quite a few in my home state.
http://kff.org/health-reform/issue-...states-that-do-not-expand-medicaid-an-update/

 

[nRomaleos]

That's what was unclear to me, since none of the articles I read about the decision even mentioned the coverage gap. I support the ACA, but I think it's disingenuous for the Obama administration to proudly declare that it's here to stay without acknowledging that 3.7 million people in the US are still uninsured, including quite a few in my home state.
http://kff.org/health-reform/issue-...states-that-do-not-expand-medicaid-an-update/

It is safe to assume your state's governor is republican. Perhaps, he can explain why he is refusing federal support to expand Medicaid.

still status quo, but slightly more focused than that....it verified that people buying on the federal exchanges (from states that didn't set up state exchanges) could still get the tax credit. The language of the law was "exchanges run by the state" and that was conflict

hey man. i'm starting to like you.

 

[Rainbow Zebra]

6 to 3, not a narrow victory like the last 5-4 decision. SCOTUSCARE now??? 6.4 million folks get to keep their coverage. A good day in America

 

[deleted480308]

6 to 3, not a narrow victory like the last 5-4 decision. SCOTUSCARE now??? 6.4 million folks get to keep their coverage. A good day in America

I'll repeat....this case would not have ended the ACA. All this decision did was ensure tax credits for those purchasing via federal exchanges in states with no state exchange

 

[mk04447]

Interesting. I still think it's best to be safe and call it the Affordable Care Act, though. I view "Obamacare" as being a slang term, and I try not to use slang in interviews for anything. I feel like using slang in interviews is just too casual, and some view it as unprofessional. Many interviewers might not care, but I feel like there are at least some who would prefer that you don't.

I say Obamacare, that way people know I'm one of the good guys.

 

[MTGPGE]

It is safe to assume your state's governor is republican. Perhaps, he can explain why he is refusing federal support to expand Medicaid.

"Something something states' rights federal bureaucratic intrusion something something" is what she generally goes with.

 

[Rainbow Zebra]

I'll repeat....this case would not have ended the ACA. All this decision did was ensure tax credits for those purchasing via federal exchanges in states with no state exchange

And if all the folks in the fed exchange lost the subsidy, I guess they would just work harder to pay for it?? The subsidy is a major hallmark of the ACA, no doubt about it. Letting it stand was right, and I got a bunch smart lawyers to back me up (and Scalia ain't one of them, though his dissent was quite entertaining).

 

[nRomaleos]

"Something something states' rights federal bureaucratic intrusion something something" is what she generally goes with.

 

[deleted393595]

According to them. I try not to open it up too much for discussion. I could be wrong, but doesn't Obamacare support Medicare in some ways?

Nope. The ACA gouges Medicare funds to pay for the insurance subsidies.

 

[deleted393595]

I'll repeat....this case would not have ended the ACA. All this decision did was ensure tax credits for those purchasing via federal exchanges in states with no state exchange

True. It would take legislative action to fully repeal it. But it would have taken out one of the legs than the law stands on, which would have hastened its repeal.

I live in a very Red state. It is immensely popular. People may not say it because of their political affiliations/leanings, but the number of people impacted by it directly or have family that have been significantly impacted by it is quite substantial and will only grow. Don't get me wrong, I will make less money over my career secondary to all of these changes and will see more patients. But, from a population standpoint, this helps increase access, which will be popular over time. You generally just don't hear the lower class voice early on .

I disagree with this. Yes, it will increase access to basic services. But expect coverage for expensive procedures (Eg knee replacements) to be phased out over time. Also, most patients will turn down care to save money because the "subsidized" insurance from the marketplace has huge deductibles. Functionally, it's nothing more than a slightly less cruddy version of Medicaid packaged as "Bronze", "Silver", "Gold" and "Ripoff".

Key point: Coverage =/= Care

Also, improving access to healthcare does not improve health outcomes. That was proven by the Oregon study, and that's what public health stuff is for.

Not to mention that the top-down planning within the bill is going to make healthcare laughably worse.

 

[deleted393595]

"Public approval of health care law" is not the same as a program being popular or continuing to grow.

+1. The government that robs Peter to pay Paul will always have the support of Paul.

 

[Dares Dareson]

Could someone explain what the the new ruling implies for future physicians applying to medical school in the coming years?

Conservatives/Libertarians: "IT'S THE END OF THE WORLD! DROP OUT OF MED SCHOOL NOW!"

Everyone else: "Not much."

So you tax the middle class to pay for the lower class then what? Middle class can't afford their insurance so they have to be on obamacare instead of private. It is 100% socialism and it doesn't work. Just look at how mediocre Europe's everything is...

If anything, "100% socialism" would be the single payer plans in Canada, the UK, France, Germany, Italy, most of the rest of Europe, Japan, South Korea, Australia, and pretty much every developed country--and a lot of poorer ones too. Obamacare is a conservative plan. Progressives/Liberals/Real Democrats wanted single payer. And considering Europe beats America in pretty much everything except infant mortality and gun deaths, they may be on to something.

That's kind of why I was asking. My Grandma has been pitching a fit about Obamacare for some time and can't wait to see entitlements like that repealed. She says its negatively affecting her medicare--which you can pry from her cold dead fingers because that's the only way she's giving it up. I don't completely understand that aspect and Grandma certainly isn't the voice of reason on this one . . .

Grandparents pitch a fit about whatever lies Fox News tell them. The problem is they then go and vote based on those lies, whereas young people skip voting because "both parties are the same."

 

[WingedOx]

ugh... this case was about a single wording "error" of a single section of the bill/law.

Absolutely nothing changed as a result of today's ruling and even if it went the other way, it would have resulted in a headache and scrambling for individual states and not a whole lot else.

/but please carry on with your off topic discussion.

edit: credit to @sb247 for beating me to it. Appreciate your factual correctness despite vastly different political opinions. (my bad for not reading the whole thread, though this one is actually more intelligent than both threads on Allo)

 

[WingedOx]

So you tax the middle class to pay for the lower class then what? Middle class can't afford their insurance so they have to be on obamacare instead of private. It is 100% socialism and it doesn't work. Just look at how mediocre Europe's everything is...

I come from an area with some of the most insanely regressive taxes in the country. Somehow I'll get over the "socialism".

 

[WingedOx]

Btw, if anyone else out there follows SCOTUSblog on twitter, they're usually a riot on days like today.

 

[NickNaylor]

ugh... this case was about a single wording "error" of a single section of the bill/law.

Absolutely nothing changed as a result of today's ruling and even if it went the other way, it would have resulted in a headache and scrambling for individual states and not a whole lot else.

/but please carry on with your off topic discussion.

edit: credit to @sb247 for beating me to it. Appreciate your factual correctness despite vastly different political opinions. (my bad for not reading the whole thread, though this one is actually more intelligent than both threads on Allo)

I think this analysis is really off the mark and not quite accurate. Look at Scalia's dissent - a page and a half is dedicated to highlighting the fact that this "single" errant phrase is hardly that. The thrust of his opinion is, in fact, that there are many areas within the bill where distinctions in the terminology used are relevant and significant. It's not as if the section is question is the only place this particular phrase ("Exchange established by the State" vs. "Exchanged established by the State or Federal Government/HHS/whatever") can be found. That distinction is littered throughout the bill in different contexts.

IMO the final decision was more political than judicial - i.e., it would've been a huge political problem to undo this portion of the bill, and avoiding that scenario was of utmost importance. The assumption was assumed and the legal argument fit to the result. I find Scalia's dissent convincing. When I read the opinion of the first ACA case, I found the whole tap dance of "tax vs. penalty" to be entirely unconvincing. I find this opinion to be similarly unconvincing.

 

[WingedOx]

Please. I can concede that the original ruling was Roberts shoehorning pragmatism into a ruling, but the entire King argument was little more than a political and judicial hail mary.

Finally, the structure of Section 36B itself suggests that tax credits are not limited to State Exchanges. Section 36B(a) initially provides that tax credits “shall be allowed” for any “applicable taxpayer.” Section 36B(c)(1) then defines an “applicable taxpayer” as someone who (among other things) has a household income between 100 percent and 400 percent of the federal poverty line. Together, these two provisions appear to make anyone in the specified income range eligible to receive a tax credit. According to petitioners, however, those provisions are an empty promise in States with a Federal Exchange. In their view, an applicable taxpayer in such a State would be eligible for a tax credit—but the amount of that tax credit would always be zero. And that is because—diving several layers down into the Tax Code—Section 36B says that the amount of the tax credits shall be “an amount equal to the premium assistance credit amount,” §36B(a); and then says that the term “premium assistance credit amount” means “the sum of the premium assistance amounts determined under paragraph (2) with respect to all coverage months of the taxpayer occurring during the taxable year,” §36B(b)(1); and then says that the term “premium assistance amount” is tied to the amount of the monthly premium for insurance purchased on “an Exchange established by the State under [42 U. S. C. 20 KING v. BURWELL Opinion of the Court §18031],” §36B(b)(2); and then says that the term “coverage month” means any month in which the taxpayer has insurance through “an Exchange established by the State under [42 U. S. C. §18031],” §36B(c)(2)(A)(i). We have held that Congress “does not alter the fundamental details of a regulatory scheme in vague terms or ancillary provisions.” Whitman v. American Trucking Assns., Inc., 531 U. S. 457, 468 (2001). But in petitioners’ view, Congress made the viability of the entire Affordable Care Act turn on the ultimate ancillary provision: a subsub-sub section of the Tax Code. We doubt that is what Congress meant to do. Had Congress meant to limit tax credits to State Exchanges, it likely would have done so in the definition of “applicable taxpayer” or in some other prominent manner. It would not have used such a winding path of connect-the-dots provisions about the amount of the credit.5

The alternative is what? to make the assumption that Congress meant to derail their own bill because of poor drafting (Roberts actually makes a snarky point about the quality of the bill's drafting and organization one of his footnotes). The King argument was of little more quality than when my nephew attempts to get out of bedtime by claiming that when we said he had to go to bed after the 3rd inning of the baseball game on TV, we didn't say "which" baseball game. There are clearly other games on the West Coast that haven't started yet, and clearly that could have been our intent when we told him this, right? Little more than a judicial game of "gotcha".

 

[NickNaylor]

Please. I can concede that the original ruling was Roberts shoehorning pragmatism into a ruling, but the entire King argument was little more than a political and judicial hail mary.

The alternative is what? to make the assumption that Congress meant to derail their own bill because of poor drafting (Roberts actually makes a snarky point about the quality of the bill's drafting and organization one of his footnotes). The King argument was of little more quality than when my nephew attempts to get out of bedtime by claiming that when we said he had to go to bed after the 3rd inning of the baseball game on TV, we didn't say "which" baseball game. There are clearly other games on the West Coast that haven't started yet, and clearly that could have been our intent when we told him this, right? Little more than a judicial game of "gotcha".

I think there are arguments to be made either way. The thrust of the Court's opinion was, in effect, that it is the place of the judiciary to repair bills that are horribly written and play the role of backup legislator - in this case, as Scalia writes, making things mean what they quite clearly don't mean. The dissent's argument, on the other hand, is that the text should be read as it is, mistakes or not. His entire argument his demonstrating that this isn't a random typo or an incorrect copy/paste in the wrong section of the law. Because the text says what it does and appears to be done so intentionally, he interprets it as it is written.

I'm a literalist. I look at what's on the page and I read what's written, and I take things as they are. I'm not a fan of hand-waving and making things mean what they don't mean. Because of that, I'm more biased to the dissent's opinion than the majority's. The implicit argument in the majority's opinion that it is the role of the Court to correct these legislative errors should they come to light. Scalia's argument - and I agree with him - is that if this was, in fact, a mistake, then the legislature should simply go back and repair the bill, something that is, at it's core, a completely trivial measure.

Of course, though, that isn't going to happen because politics. But that's the price of democracy, and I don't find that reason in and of itself enough to uphold questionable law. I don't like this move not because it has anything to do with the ACA (I think the endless effort to repeal/defund/otherwise destroy the ACA is, at this point, a complete fool's errand) but because it weakens the political process. It divorces our representatives from their decisions and, instead, allows them to be repaired via a process which the electorate has very little direct control over (and rightfully so) and diffuses responsibility from those that should be held accountable to those that cannot (and should not). We continue to further kick the can down the road of promoting a representative body which is ever less responsive to the demands of its constituents. I think the correct move is to let the damage be done, punt this back to the legislature where, surely, nothing will happen, and allow the political process to operate. This process is at once undemocratic and yet highly political. I'm not a fan of that, and given that this is a SCOTUS ruling, I think it could potentially open the gates to a dangerous path of giving the judiciary duties which are more appropriately in the realm of the legislature.

I'm not a jurist, so I do not pretend to know the intricacies of various legal tests and the correct process by which a jurist uses intent or text to rule on the meaning of a statute. However, I accept that all of the people on the SCOTUS are reasonably intelligent people and not complete hacks, thus I think their arguments are at least worth considering. The majority clearly interpreted the law using legislative intent. The dissent did not. There seems to me, at least, to be at least those two reasonable lines of different conclusions about the same issue. I think it's intellectually dishonest to simply dismiss the dissent as "oh, there goes those crusty ol' conservatives again" without actually seriously considering the arguments in a fashion that is as unbiased as possible.

 

[deleted393595]

When I read the opinion of the first ACA case, I found the whole tap dance of "tax vs. penalty" to be entirely unconvincing.

Also basing that decision on Wickard v Filburn, which in itself was a terrible decision.

 

[Flintwire]

And considering Europe beats America in pretty much everything except infant mortality and gun deaths, they may be on to something.

Please don't throw around the infant mortality rate and other health related metrics and use them to show how we're so backwards and inefficient.

If you research the numbers behind infant mortality you'll see that many other countries aren't as strict in their definitions of "live births" as we are, aren't as careful in their record keeping as we are, etc. etc. ALSO, we've decreased infant mortality (in 1st world countries) to an incredibly low level compared to where it was before. We're not even talking a huge difference between countries at this point. Although every child that dies is a horrible tragedy, we're at approximately 6 deaths per 1000 live births, and the number one country is around 2 deaths per 1000 live births.

Considering all the issues with the reporting and definitions and other populations and etc. that skew the numbers, a difference of 4 deaths per 1000 isn't a reason to tout the superiority of any country over the US.