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Topic: Politics
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 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.

June 27, 2013 | Posted By Marleen Eijkholt, PhD

Sarah is a 10-y old girl with cystic fibrosis who, until recently, was in desperate need of a lung transplant. The doctors had estimated that Sarah would only have a couple more weeks to live without a transplant. Recent news headlines reported about her quest for this transplant, the success of the operation and, over the weekend, they issued the happy news about her regaining consciousness. Most of this news paralleled comments about the battle to revise the legislation, and underscored antagonism towards policy or policy makers (lawyers and ethicists), as if hindering good medicine. 

In this post I would like to comment on this antagonism, and propose that the policy makers did quite a good job in Sarah’s case. I propose that we need a symbiotic relation between medicine and policy makers. As a clinical ethicist with a background in law, I feel a lot of fear for ‘lawyers’, and prejudice against the idea that law, ethics and medicine can go together. In this post, I seek to outline how they can go together, and how Sarah’s case provides an opportunity for partnership. I must note here, however, that this issue is a minor one given the terrible ordeal of all the involved individuals.

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 27, 2012 | Posted By Bruce D. White, DO, JD

In 2012, the percentage of money spent on providing drugs to patients in the United States continued to rise (Hoffman et al., 2012). However, this is a US trend not seen in other developing countries – such as Canada – where national drug expenditure percentages are slowing year after year (CBC News, 2012). In fact, in Canada, the rate of drug cost growth for this year is the lowest of the last 15 years. 

So, why? Simply put, the American pharmaceutical industry has fueled new drug innovation worldwide for decades. Now, the pharmaceutical companies have less money for research and development and are innovating less. When they do innovate, the companies spend their R&D allocations either on “me too” (imitation) drugs, or very, very expensive drugs for which insurance reimbursement is maximized. Market forces drive both these new drug lines. But now, the R&D well is clearly drying up (Adams, 2011).

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.

November 1, 2012 | Posted By Paul Burcher, MD, PhD

When former President Bill Clinton spoke at the Democratic National Convention, he argued that we must put aside ideologies to “get things done.’”  The implementation of the Affordable Healthcare Act (ACA) is challenging Republican governors on exactly this point, and their responses are not uniform.  Jan Brewer, governor of Arizona outspoken critic of President Obama and the ACA, has begun planning for, and implementing the healthcare exchanges that states must create under the rules of the legislation.  States that fail to plan for exchanges will have exchanges created for them by the federal government. Six states with Republican governors have decided not to create exchanges, and may also not accept additional money from the federal government to expand Medicaid coverage along the lines set out by the ACA.

Is this just politics as usual, or is there an ethical dimension to this partisan debate?  I would argue that to fight against Obamacare to the detriment of the health of a state’s citizens—the poorest of the states citizens—is a violation of a politician’s duty to beneficence.  Uninsured patients suffer a preventable harm from the lack of access to healthcare, a harm that is now being remediated by the ACA, but only if only states will fully implement its policies.

July 23, 2012 | Posted By Hayley Dittus-Doria, MPH

As the world knows, obesity has become a public health epidemic over the last several years in the United States, with over 35% of US adults falling into the obese category.  But when public health experts and lawmakers try to “do the right thing” by forcing people to engage in healthier behavior, are they going too far?

In a June 8th article on CNN.com, Harriet Washington believes that the ban on sugary drinks that New York City mayor Michael Bloomberg has proposed is the wrong way to go about encouraging healthy eating and drinking habits.  She also disagrees with “sin taxes,” stating that they often have unintended consequences.  In the sugary beverages ban proposal, restaurants, street carts, and movie theaters would not be able to sell any sugary drinks over 16 ounces.

While I don’t necessarily support an outright ban of sugary drinks, I do think that, for the most part, taxes imposed on items (such as those for tobacco and alcohol) are a great step toward  discouraging people from partaking in these unhealthy behaviors and increasing state revenue at the same time.  Many states have implemented a tax on sugary beverages in recent years, and many others have tried, but failed, for a soda tax to catch on.  Mayor Bloomberg even proposed a soda tax in 2009 for NYC, yet this proposal was eventually abandoned and never came to fruition.

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.

July 5, 2012 | Posted By Bruce D. White, DO, JD

The Wednesday, June 27, issue of the Washington Post reported that the U.S. Senate passed a bill empowering the Food and Drug Administration (FDA) to collect about $6 billion over the next five years in new “user fees.” The bill passed the Senate 92 to 4 and now goes to the White House for President Obama’s signature.

The bill for the first time requires generic drug manufacturers to make payments to the FDA as part of the drug approval, manufacturing, and marketing process. “Innovator” (or what old-timers might recall as “ethical” or “brand name”) pharmaceutical manufacturers have been paying similar user fees since the passage of the Prescription Drug User Fee Act (PDUFA) of 1992. The user fees were seen as a “private industry” approach with manufacturers being required to shoulder some of the drug regulatory and safety processes costs. Generic manufacturers will contribute about $300 million annually. In return, the FDA has agreed to help speed the approval process for generics.

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.

 

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.

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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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