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Topic: Health Insurance
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.

June 29, 2012 | Posted By Posted By David Lemberg, M.S., D.C.

There appears to be hope for America, as a society, a democracy, and a nation. On Thursday, 6/28/2012, as everyone knows, the Supreme Court upheld the constitutionality of the Affordable Care Act (ACA) by a 5–4 vote. Much was at stake, not the least of which was the possibility of affordable health care for all Americans. But beyond this extremely important outcome, the very nature of our democracy was in play, as well as the potential success or failure of the American political enterprise.

For example, lack of affordable health care for every American diminishes our national enterprise in all sectors.

There are other important considerations involved in how the attack on the ACA played out, including the continuing degradation of our use of language. For example, the Supreme Court justices are consistently characterized as “conservative” or “liberal”. This is an immediate problem, as their individual identities are subsumed in the right vs. left dichotomy. But the meanings of the epithets are also lost. To be conservative means to uphold tradition. To be liberal means to uphold progress. However when justices hold their ideologies closely, neither tradition nor progress receive a fair evaluation. As Hannah Arendt states in Between Past and Future, “the very quality of an opinion, as of a judgment, depends upon the degree of its impartiality”. Ideology is not impartial, and Supreme Court opinions have long appeared to be based on politics rather than justice. Obviously, such a state of affairs is a major problem for a democratic society.

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.

April 19, 2012 | Posted By Posted By David Lemberg, M.S., D.C.

Something remarkable is happening in the world of medicine (the field is often considered a monolithic special interest group). On April 4, 2012, nine medical specialty societies released lists of the "Top Five" services that are the most expensive and "have been shown not to provide any meaningful benefit to at least some major categories of patients". These nine lists are the first results of the "Choosing Wisely" campaign, launched by the American Board of Internal Medicine in response to a 2010 article in the New England Journal of Medicine.

That article challenged physicians to take the lead in health care reform. Rather than waiting for the government to impose new standards and regulations, the article encouraged physicians and professional medical societies to identify wasteful services and procedures that could be readily eliminated.

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.

April 5, 2012 | Posted By Posted By David Lemberg, M.S., D.C.

Last week's historic three days of arguments before the Supreme Court on the merits of the Affordable Care Act provided many head-scratching moments. Those naive enough to believe that the case was actually going to be considered on constitutional grounds (this being the Supreme Court, after all) were rudely awakened to an apparent actual agenda of partisan politics and corporate interests.

Broccoli was a key theme, startling the 50 million Americans who may be able to purchase green vegetables at the local market but are unable to purchase badly needed health insurance. The welfare of health insurers was a second prominent theme, providing concrete evidence to those who posit that our nation is no longer a government of the people, but rather a "government of the corporation".

The outrage has been profound, including Op-Ed pieces in The New York Times, featured articles in The New Yorker, and commentary in the New England Journal of Medicine.

First, the produce. During the second day of arguments, Justice Scalia attempted to define the market for health care. He said ". . . you define the market as food, therefore everybody is in the market; therefore, you can make people buy broccoli." Chief Justice Roberts picked up the theme as easily as if he were choosing a ripe cantaloupe at his local farm stand. Roberts informed us that "a car or broccoli aren't purchased for their own sake, either." Broccoli is purchased to cover the need for food, we were sagely advised.

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.

March 30, 2012 | Posted By Posted By David Lemberg, M.S., D.C.

It has been a very busy week at the Supreme Court. Three days of arguments on the various challenges to the Patient Protection and Affordable Care Act each merited front-page coverage in The New York TimesSCOTUSblog, the blog of the Supreme Court, received more than 800,000 hits in three days, which was more than the site has received in its first 4 years of existence. Regardless of the court's final ruling (expected on June 28th), the active engagement in our robust democratic politics of so many Americans and interested parties worldwide bodes well for the future of our way of life. Separation of powers, first described and promulgated by John Adams (second president of the United States) in his treatise, Thoughts on Government, Applicable to the Present State of the American Colonies, is alive and well.

It's easy to experience the ebbing of America's power. Our national political scene is a toxic partisan shambles. We have been severely depleted — our blood and treasure have been unthinkingly squandered in 10 years of geopolitically useless war in Iraq and Afghanistan. We are beset by real threats to our welfare and continued existence . . .

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.

March 25, 2012 | Posted By Posted By David Lemberg, M.S., D.C.

On Monday, March 26th, 2012, the Supreme Court will begin hearing arguments on National Federation of Independent Business v. Sebelius and two linked cases, the lawsuits against the Patient Protection and Affordable Care Act (ACA; signed into law by President Obama on 3/23/2010). The court announced on February 21st that it would hear 6 hours of arguments over 3 days, an historic and unprecedented amount of time. The last time the Supreme Court heard more than 2 hours of arguments was when it considered the McCain-Feingold campaign finance law in 2003.

At issue in the cases before the Supreme Court is the constitutionality of federal involvement, interference, or interposition (depending on who's doing the interpreting) regarding activities of private citizens and activities of the states. The question of constitutionality of the ACA relates specifically to the Commerce Clause (U.S. Constitution Article 1, Section 8, Clause 3). The Commerce Clause states "Congress shall have power to regulate commerce with foreign nations, and among the several states, and with the Indian tribes". As with all clauses of the Constitution, the Commerce Clause must be interpreted and applied. The Supreme Court is the final arbiter and interpreter of all such applications, declaring the constitutionality (or lack thereof) of congressional and state legislation.

The challenges to the ACA state that the federal government has exceeded its constitutionally enumerated powers. The Tenth Amendment states "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people." The challenges suggest that the ACA attempts to wield a federal power that does not exist under the Constitution and attempts to interfere with powers appropriately "reserved" to the states and to "the people". The challenges assert that it is the right of a citizen, rather than a prerogative of the federal government, to determine whether she will purchase health insurance. The challenges also assert that the federal government cannot dictate how a state conducts its Medicaid program.

 

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.

February 20, 2012 | Posted By Posted By David Lemberg, M.S., D.C.

Contraception, women's rights, and religious freedom have dominated the headlines in recent weeks. New guidelines require new health insurance plans to fully cover women's preventive health services, including the provision of birth control pills without co-payments. The administration estimates that by 2013, 34 million American women aged 18 to 64 will receive the benefits specified in the new ruling. Naturally (also, sadly), considering that this is the United States, a firestorm of ill-will began gathering in response. Lately the anti-contraception forces have been in full cry.

The rights of women to a full range of preventive health services are the main concern of the new guidelines. Women's health requirements are not the same as those of men. Also, if we take a breath and step back from this latest manifestation of America's highly destructive "culture war", we might notice that this entire argument could be avoided by instituting a single-payer health care system.

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.

February 16, 2012 | Posted By Ricki Lewis, PhD

“Are you still collecting stories about DTC testing? I've got one for you!” my grad student L.W. e-mailed a few days ago. Little did I know her family's experience would change my mind about direct-to-consumer genetic testing.

L.W. had taken my online course “Genethics” in 2008 for the master’s program at the Alden March Bioethics Institute of Albany Medical College. For one assignment, students choose a DTC testing company, peruse the website, and indicate 3 tests that they would take and 3 that they wouldn't – and why. 

As a class activity, L.W. didn’t really approach the testing seriously. “It's fun cocktail party info. ‘Why, yes, I'd love another mocha cappuccino at 9 pm. No problem... I'm a fast caffeine metabolizer!’” 

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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