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Topic: Health Insurance
November 25, 2013 | Posted By Wayne Shelton, PhD

The political right in the U.S. has mounted a formidable effort from the outset to mischaracterize the aims of the Affordable Care Act (ACA) and to mislead voters about the need for fundamental reform in healthcare. I take it as a given that the opposition to the ACA has never been about its efficacy to promote certain goals to expand coverage for more Americans; even if the ACA accomplished its goals perfectly, those on the extreme political right would still oppose it. That is, the opposition from the political right is not about whether or not the ACA will work effectively but about ideology—they oppose the ACA as a matter of principle. They are committed to the view that government should not be involved in healthcare and fear, perhaps rightly, that if the ACA proves workable it would lead to a single payer system of universal coverage for all citizens. They apparently see healthcare services being like any other market service provided in a capitalistic society. But upon even a superficial analysis, this position is flawed.

It is basic to free markets that the ability of an individual to use a certain service or product is a function his or her ability to purchase it. One of the few services that is an exception in our current capitalistic society is healthcare, albeit only at the level of requiring services at an acute level. For example no matter how desperately I need transportation to go back and forth to work, I will not get a free car as a function of someone else’s obligation to provide it. This is not true of healthcare: even if I cannot pay for healthcare or I lack healthcare insurance, if I get sick enough and show up at an Emergency Room, I’ll not only be stabilized, I’ll be hospitalized and be given all I need to improve, or more fittingly, to be rescued from dying.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

October 28, 2013 | Posted By Jane Jankowski, LMSW, MS

With contentious changes afoot in the US healthcare system these days, one old problem seems to be gaining important attention as the public reflects on what will change with the advent of the Affordable Care Act. The cost of prescription medications is often so high; patients are forced to make tough choices in order to maintain their health without going broke. This topic was front page news in the New York Times (New York Times October 2013 ) this month where the focus was on escalating costs of asthma drugs. Compared to other nations, the expense of many common – and even not so common – medications is dramatically higher for consumers in the US. This is hardly news, and studies have been done showing that senior citizens were historically the hardest hit by medication costs given the intersection of age related health problems and fixed incomes with no prescription benefits. Though somewhat ameliorated when Medicare D was added, not all of the medication problems are resolved, particularly when an individual requires skilled nursing care in a nursing home (Medicare D and Nursing Home Residents.)

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

October 25, 2013 | Posted By Wayne Shelton, PhD

In the summer of 2009 when the Patient Protection Affordable Care Act, also known as the Affordable Care Act (ACA) and Obamacare, was being widely discussed as a front burner political issue, I attended a town hall meeting held by my congressional representative, a moderate democrat, to listen to public comments before he decided whether or not to support the ACA. In the years following the disappointing implosion of healthcare reform during the Clinton administration, honestly, I did not expect to see the issue of healthcare reform back on the political agenda in my lifetime. So I was eager to attend and lend my support for a bill that would expand healthcare coverage for Americans and to hear my congressman respond to questions. When I arrived I was struck by the number of attendees and even more so by the large number of signs and placards with crude slogans linking ACA death panels, Nazism, killing grandma, etc. It was also striking that many of the people there were local working people who were members of the newly formed Tea Party and fierce opponents of the ACA. The negative views being expressed were passionate and urgent: Passage of the ACA would take our country down a path toward socialism, loss of freedom and government interference into the sacred domain of the physician-patient relationship.

Now that the ACA has passed both chambers of congress, signed by the president and ruled to be constitutional by the Supreme Court, there are still strong efforts by it opponents to stop its implementation. At present, the right wing of Republican Party in the house of representation has been willing to shut down our government and threaten default on our national debt unless the ACA is repealed or delayed. It is instructive to put the recent efforts to derail the ACA into historical context and see them as an extension of a century long effort, led by well-funded special interests groups to motivate American citizens through misinformation and scare tactics to vote against their own interests.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

January 14, 2013 | Posted By Jane Jankowski, LMSW, MS

In the wake of the Sandy Hook Elementary tragedy and the movie theatre massacre in Colorado, accounts of mentally ill perpetrators are offered as partial explanations as to how these horrific events came to pass. The public outcry for revised gun control measures is understandable and well placed. I don’t disagree. Yet, the predictability of which firearm aficionados may also harbor a latent predisposition toward violence may be an unreasonable task for agencies tasked with licensing weapon worthy citizens, particularly when it comes to assessing someone with a history of mental illness. The paradox of a system which relies on questions about a personal history of psychiatric treatment does not mean an individual has not needed care.  If behavioral health services are not accessible or available, there would not be any record of such intervention. This does not mean that such intervention has not been suggested, desired, or otherwise indicated.  That said, a history of mental health treatment ought to not automatically suggest the applicant should be denied a right offered other citizens.  Focusing funding and effort on firearm marketplace controls may override the much needed attention on community mental health care which are lacking across the nation.  Ensuring our nation also has accessible, high quality behavioral health treatment programs will have benefits which extend far beyond the gun control debates.  Though we may never be able to fully disentangle the issues of gun rights and mental illness, perhaps we can maximize this opportunity to press our leaders into putting some real muscle, in the form of dollars, behind mental health treatment programs.  

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

December 12, 2012 | Posted By Wayne Shelton, PhD

Recently, I attended a debate between two very informed health care professionals about whether or not our country should have a single payer health care system. Each seemed to have their own philosophical or ideological perspective about health care as a basic service in our society and it through their ideological lens that each speaker viewed health care and brought to bear the facts to support their positions. It was striking that these two very informed and thoughtful individuals often disagreed about fundamental facts pertaining to our health care system. 

For example, the opponent of a single payer system supported his claim that turning over health care to the federal government would be a failure at least in part on the assumption government is incompetent to perform this task. He claimed, as other thoughtful conservatives do, that that Medicare and Medicaid are less efficient than private health plans. If the analysis in the first link below, which is part of the Ryan Plan, is true, then perhaps there are some facts to support their case.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit ourwebsite.

September 21, 2012 | Posted By Bruce D. White, DO, JD

In a recent article about medical repatriation in a national bioethics journal, philosopher Mark Kuczewski argues that the practice can be an “ethically accepted option” only if three conditions are met:

  1. Transfer must be able to be seen by a reasonable person as being in the patient’s best interests aside from the issue of reimbursement.
  2. The hospital must exercise due diligence regarding the medical support available at the patient’s destination.
  3. The patient or appropriate surrogate must give fully informed consent to being returned to another country.

Surely Dr. Kuczewski knew – when he wrote the article – how completely absurd these three “conditions” or prerequisites are?

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

September 13, 2012 | Posted By Wayne Shelton, PhD

The Supreme Court ruled this past June that the Affordable Care Act (ACA), otherwise known as Obamacare, was indeed constitutional. But this ruling only occurred when Chief Justice came over to the more liberal side. However, he made it clear that the basis for its constitutionality could not be the commerce clause but rather the right of the federal government to impose new taxes. That is, the government could not require citizens to buy certain services but they could, via elected representatives, impose new taxes to support those services. On the conservative side, there seems to be the notion that health care itself is a normal market service or product like any other. Requiring someone through the imposition of a mandate to purchase health care is therefore the same as requiring them to purchase broccoli. Though most of us on the liberal side are glad that the ACA was deemed constitutional, it causes us considerable pause to leave just a wrongheaded legal understanding embedded in our public policy moving forward.

Broccoli has many health benefits. It is filled with vitamin A and C, folic acid, calcium and fiber. It may help prevent high blood pressure and colon cancer. And it’s really delicious steamed up as an accompaniment with other vegetables and almost any meat or carbohydrate. In fact I would prefer to spend the remaining time in this blog describing all the ways broccoli can be enjoyed and used to promote health. But my point here is only to say, as wonderful as broccoli is, it is dispensable in one’s diet. Former President George H. W. Bush famously claimed his right to refuse to eat broccoli any longer because he was now president and could do as he wished. He just didn’t like it. And as difficult as I find it to empathize with such a sentiment, I must say, it makes virtually no practical difference either to former president Bush, society and to the marketplace in which broccoli is sold. He will hopefully find other vegetables he finds more palatable or take vitamin supplements, or just hope that his genes help him get to a long life. There are countless market products and services just like broccoli, in terms of being really, really good for you, but if you don’t buy them, neither you nor the rest of society will be harmed.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

September 11, 2012 | Posted By Jane Jankowski, LMSW, MS

Plans are underway at some drug store chains and other discount retailers to open in-store clinics which will offer an expanded menu of low cost vaccines and basic clinic services to consumers. Vaccines for flu and pneumonia have been available at retail locations for a number of years, and have become a familiar practice at drugstore chains and other retailers particularly during autumn when the newest flu vaccines are available. A folding table and chairs, consent forms, alcohol swabs and a sharps container typically wait at the end of often long lines of people seeking these prophylactic shots. More recently, several retailers began opening in-store clinics and current estimates of existing in-store clinics hover around 1,300. The pending expansion of these clinics may bring the numbers up to over 3,000 within the next 3 years. 

The self-proclaimed low price leader, Wal-Mart, plans to open independently owned and operated in-store clinics which will treat walk-in patients seven days a week. The list of services ranges from acne care and common vaccines to flu treatment (for those who missed the Wal-Mart flu shots) and upper respiratory infections. It seems reasonable to presume that other in-store clinics are or will be similarly equipped. For the millions of Americans who have difficulty accessing primary care, this may be a tolerable solution which falls somewhere in between going to the ER for these routine healthcare issues and having a primary care physician who can provide comprehensive on-going care. As noted in a piece printed in The Detroit News, the Affordable Care Act will thrust millions of newly insured patients into the waiting rooms of medical offices clogging an already strained primary care system. Perhaps the locating clinics in popular stores is a kind of outreach for clinic owners who  have been unsuccessful in efforts to provide care to underserved populations. I am not convinced these clinics represent such altruistic intentions. This expansion of medical services raises questions about whether or not this venue truly supports the best interests of patients.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit ourwebsite.

August 7, 2012 | Posted By Bruce White, DO, JD

With the Supreme Court upholding the individual mandate of the Affordable Care Act (ACA) constitutional but rejecting the notion that the states had to expand their Medicaid program to cover a significant percentage of the populations, some inequities in health care delivery will only grow.

One might use any number of examples to illustrate identified expected unfairness. For the relatively poor Southern states – Alabama (AL), Louisiana (LA), and Mississippi (MS) – patients covered by Medicaid and the Children’s Health Insurance Program (CHIP) is significantly higher than the national average now. With the proposed ACA expansion in these three states effected by 2019, the percentage of Medicaid & CHIP-eligible populations would swell from 20% to 27% (AL), 26% to 34% (LA), and 26% to 37% (MS). In Louisiana and Mississippi, these percentages are approaching the number of persons in the state who have traditional private health insurance. [The projected numbers used here are from the Kaiser Family Foundation Website.]

Moreover with the increased numbers of patients who will have Medicaid and CHIP coverage, proportionately more practitioners will be critical in providing the care in these states. Is it realistic to think that Alabama, Louisiana, and Mississippi, will be able to grow their provider availability by 37%, 32%, and 41% in four years to meet the demand? The national average is 25.7 active physicians per 10,000 persons. Louisiana is very close to the US mean with 24.2 physicians per 10,000, but Alabama and Mississippi are will below the national average with 20.6 and 17.3 physicians per 10,000 respectfully. Is it reasonable to assume that these states will be able to multiply their physician populations to meet any increased demand?

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

July 2, 2012 | Posted By Wayne Shelton, PhD

The decision by the Supreme Court affirming the Patient Protection and Affordable Care Act (ACA) caused many who follow health care closely to breathe a sigh of relief. About 32 million more Americans will now have access to health care insurance. One sticking point that worried many of us was the mandate in the bill requiring everyone to purchase health care. It was frustrating this past March to hear in the oral arguments comparing a requirement for citizens to buy broccoli to a requirement to buy health care, as though both are the same type of market commodities. Many on the right, such as Judges Scalia, Thomas and Alito, expressed concerns that the mandate to require everyone to buy health care was a unconstitutional, a violation of the commerce clause; whereas, many others see health care as a basic public good, which unlike broccoli, everyone requires or will require sooner or later. Fortunately, a legal consensus was reached in the ruling, with Chief Justice John Roberts moving over into the majority in the 5-4 vote. In their ruling, the mandate was not viewed as an expansion of the commerce clause, but rather as a tax, which congress has a right to impose. Regardless of the final legal justification of the ruling, many of us are pleased that the most important piece of health care legislation since Medicare and Medicaid in 1965 is now the law of the land.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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