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Topic: Health Insurance
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.

 

January 27, 2012 | Posted By Wayne Shelton, PhD

For most of the past 20 years I have had the privilege of talking with and learning from medical students in small group discussions. As medical students leave the classrooms of the first and second year and transition into the third year, they confront a new reality: they are now actually encountering patients directly for the first time and are working with physicians in the daily care of patients. The more encounters they have with patients and their families and with their clinical mentors, the more stories they have to tell, which often lead to vexing questions that shed light on many of the problems of our health care system in the United States. 

One of the common themes throughout each year is the growing disenchantment with primary care, for a variety of reasons. Most of the students are assigned at some point to a clinical mentor who is a practicing internist seeing many patients each day in a primary care setting. Students often present cases of patients with complex medical and psychosocial issues that require interaction with and support from the physician. Not infrequently do we hear accounts of how patient non-compliance is a barrier to a constructive outcome. The idea of seeing patients over time with the same medical problems, while not heeding medical advice, strikes many students as a frustrating aspect of primary care. Also the students talk of these same physicians continuing to work into the evening, doing mountains of administrative work because of multiple insurance forms to complete. 

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.

December 15, 2011 | Posted By Lisa Campo-Engelstein, PhD

In August of this year, the Department of Health and Human Services announced that, as part of its preventive health initiative under the Patient Protection and Affordable Care Act, insurance companies would be required to provide birth control with no co-pay beginning in August of next year. This decision empowers women to have more control over their reproduction and should (hopefully) decrease the percentage of unintended pregnancies, which currently stands at a shockingly high 50 percent. Evidence shows that the medicalization of contraception—that is, positioning physicians as gatekeepers to contraception—increases cost and decreases access. In evaluating what contributes to unplanned pregnancy, 54 percent of women stated cost as an obstacle to contraception use and 66 percent claimed that an inability to obtain contraception played a role.

Today there are eleven contraceptive options for women: female condom, tubal ligation, cervical cap, diaphragm, implant, injectable, IUD, patch, pill, ring, and sponge. On the whole, female methods tend to be more expensive than male methods because most require at least one physician visit and some involve a renewable prescription. Only two of the eleven female-only contraceptives—the sponge and the female condom—do not require seeing a physician. This means that 82 percent of female methods require at least one physician visit in order to acquire the contraceptive. Moreover, 36 percent of female methods require a prescription (injectable, patch, pill, and ring), which means women must continually renew their contraceptive by going to the pharmacy or doctor. Most doctors will not continue renewing prescriptions without seeing their patients yearly, so the initial visit when the doctor prescribes the contraceptive is not enough to ensure continued access to the contraceptive.   

Due to the expense of initiating and maintaining contraception, women spend 68% more out of pocket toward their reproductive health care than men of the same age. Currently 28 states mandate insurance companies to cover contraception to the same extent as they do for other prescription medications. However, 20 of these states have provisions in place for providers, plans, or employers to deny contraceptive coverage for religious or moral reasons.

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.

August 5, 2011 | Posted By Sheila Otto, MA, BSN

A student recently shared her concerns about one of her patients, Mrs. R., a 51 yr. old woman who had multiple medical problems which landed her in the hospital but who had no insurance. It seems her husband, who is her primary caretaker at home, is disabled himself and on disability. The two of them have a joint income of $200 per week, which is too much to meet Medicaid eligibility.  With pre-existing illness and no possibility of prospects for health insurance, they are about to lose their home to foreclosure. The hospital will likely not be paid.

With all the talk of budget crisis and concerns about government spending and particularly about an expanded role of government in providing health care insurance, it is easy to lose sight of patients like Mrs. R. Everyone agrees that the US financial crisis is far from over and that health care is very expensive. However, we need to think about the role of government in helping citizens who have health problems which drastically affect their ability to live, day to day, and who currently are out of the loop for insurance. We have laws in place to insure that in an emergent situation, patients must receive life-saving treatment in the ED, regardless of ability to pay. But what good does it do to pull someone back from the brink if you can’t give them the assistance to prevent the same thing from happening repeatedly? If we were to agree to a plan to cover everyone (universal health care) because it is the “right” thing to do there is still the problem of paying for the service. Like the unpopular suggestion to raise taxes, limits to services would be difficult to put in place although essential to make a plan viable. Mrs. R is a classic teaching case for tomorrow’s physicians, who are asked to put a Band-Aid on a large and gaping wound. In a way, she is a paradigm for what ails us a country….we want a fix without paying and make “progress” by pretending that an insufficient remedy is fine for now.

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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