Posts Tagged ‘health care reform’

Tribe Baits Scalia

February 9th, 2011 No comments

That’s surely what liberal Professor Laurence Tribe is doing here, right?

Given the clear case for the [health care] law’s constitutionality, it’s distressing that many assume its fate will be decided by a partisan, closely divided Supreme Court. Justice Antonin Scalia, whom some count as a certain vote against the law, upheld in 2005 Congress’s power to punish those growing marijuana for their own medical use; a ban on homegrown marijuana, he reasoned, might be deemed “necessary and proper” to effectively enforce broader federal regulation of nationwide drug markets. To imagine Justice Scalia would abandon that fundamental understanding of the Constitution’s necessary and proper clause because he was appointed by a Republican president is to insult both his intellect and his integrity.

Two predictions:

(1) Scalia, as obvious a partisan as you’ll ever find, will vote to strike down the law; and

(2) He won’t be able to resist taking on Tribe, probably in that nasty-clever way that he’s perversely perfected.

This should be good. (By “this” I mean Scalia’s response, not the possibility that the law will actually be struck down. I still don’t think that’s likely, and it would be a disaster for both the Obama Administration and the country.)

Health Care Reform Bill Passes House

March 21st, 2010 No comments

In a vote the outcome of which became evident earlier in the day, the House just passed the Health Care Reform bill. The rest will be all Sturm und Drang — in other words, endless fodder for pundits, but with no real surprises or deviation from the outcome.

I made the tragic error of listening to much of the debate tonight. Oy! A few good points raised on either side (arguing about the effect on Medicare; whether the CBO estimate can be trusted; the wisdom and enforceability of mandates), but most of it was the worst kind of bloviating. Our freedoms will be sacrified, our nation will slide into a Euro-socialist swamp, and on and on. These Representatives are living counterarguments to their own assertions about “American exceptionalism”, unless that exceptionalism is that we’re a completely negative, uncharitable people.

This is a huge victory, let us not forget amid all of the distraction.

Public Health and Welfare in State of the Union Speech

January 28th, 2010 1 comment

State of the Union

Despite my current frustration with Obama — or maybe because of it — I watched the entire State of the Union speech. I’m sure it’s being endlessly picked apart by all kinds of talking heads, bloggers, and the like. Me, I’m watching the Australian Open. (The indomitable Serena Williams just beat back a tough challenge from the letter-limited Li Na to advance to the final. No news there.) But I do want to pause to grant some limited props to Obama for mentioning two of my pet issues: Public health and the repeal of “Don’t Ask, Don’t Tell.”

The promise on DADT had generated an anticipatory, bloggy buzz, and it was heartening to hear the President speak to it. I’m confident it will happen. (Missing, though, was any mention of the Employment Non-Discrimination Act which I had thought was also likely to pass into law this year. I was reminded that this issue had been raised in a State of the Union as long ago as the end of the Clinton Administration. Can we please get there? The goal seems to shimmer and recede….)

The DADT comment came towards the very end of a pretty good speech, and very close in time to another issue near and dear to me: public health. Of course, everything the President mentions is public health to me (health care reform is just the most obvious example, but I can’t bear to talk about it right now). But to hear him pledge energy, money and effort to public health efforts to fight terrorism and infectious disease — now that was something. My night was made in five minutes.

Now, to bed. Oh, wait…the recently unretired Justine Henin is taking the court….

Paul Starr’s Raynes, McCarty Presentation

December 3rd, 2009 No comments

A recent post discussed Professor Paul Starr’s Raynes McCarty Distinguished Lecture in Health Law, and purported to link to that lecture. Unfortunately, that link was “dead.” In case you’d prefer a live one, it’s now available here (in two parts). It just went up.

It’s more timely than ever, with the Senate’s health care debate heating up, and with Starr himself having written an op-ed on the public option in last Sunday’s New York Times. Now you get the fuller explanation. It’s worth your time. And this time — it really will work.

Of Oysters and Mammograms

November 20th, 2009 No comments

“I can’t believe they would put an economic value over the lives of fifteen or more people.” (Statement of a woman whose father died as a result of eating raw oysters that contained a deadly bacteria.)

“Let the rationing begin.” (Rep. David Camp, Ranking Republican on House Ways and Means Committee, responding to U.S. Preventive Services Task Force Report that recommends women delay routine mammograms until age 50).1

Public health takes a beating again.

In the first case, the FDA has had to eat crow. Just last month, the agency trumpeted its “public health” duty to prevent a predictable number of deaths each year by banning the sale of untreated, raw oysters during the summer months. But now the FDA has been shut up by the industry and by too-powerful Louisiana Sen. Mary Landrieu. (She can pretty much get anything she wants, including her own Mardi Gras Float, at least while the health care reform bill is pending.) The agency has slunk away, murmuring something about studying “feasibility and costs.”

In the second case, the jumpy recommendation against routine mammograms (and self-examinations) to detect breast cancer has brought a howl of protests. The objection: “Yes, the test only picks up one cancer case out of every 1,900 — but what if you’re the one?” For opportunists in the Camp camp, this cold-blooded calculation serves as a timely, exploitable proxy for everything  that’s wrong about health care reform. Never mind that the proposed legislation does a dismal job at controlling anything — costs or procedures — and that rationing is a fact of life now under managed care.

And when it comes to the battle against breast cancer, stirring outrage is a pink breeze.  Anything that would lead to even one more death — period — will be decried as the heartless elevation of population-based data over real lives.

It’s not clear that federal authorities, here representing a population-based, public-health perspective, were right in either case. Perhaps they could have continued efforts at education in the first case (which the FDA said it had tried, without success for a decade), rather than requiring irradiation (which has its own PR cost). In the second case, even public health authorities are split on whether the evidence justifies the new recommendations. At least this was a non-binding task force, easily overcome by political outrage.

There are two issues here. First, public health works best when it can explain and justify its position in a way most reasonable people will find at least defensible. Even then, though, its recommendations — or even coercive steps — can be defeated when other forces (like the oyster lobby or the breast cancer survivor community) are more powerful.

But the more important point — and the one no one wants to discuss — is that we do make safety and efficiency trade-offs, all the time. We couldn’t function without doing so, either in our own lives, or societally. Would routine mammograms be cost-justified if, say, they saved one life in one million? One can always say: “What if you’re that one person?”

  1. The quote appears in Gail Collins’ reliably insightful and amusing column.

Paul Starr on Health Care Reform

November 20th, 2009 3 comments

I don’t often use this space to direct readers to something my law school is doing, but in this case I feel compelled to do just that. Yesterday, Paul Starr of Princeton delivered our annual Raynes McCarty Lecture on Health Law, and reminded us of something easy to forget: There are actually important issues of substance at stake in the current debate  over health care reform. Happily, our tech geniuses Webcast the lecture;  you can find it here.

As this brief summary of Starr’s accomplishments demonstrates, he has the credentials and the experience to place today’s debate into historical context.  His path-breaking book, The Social Transformation of American Medicine, won the 1984 Pulitzer Prize for Non-Fiction, and he was a senior advisor to the Clintons during their effort to pass health care reform. Like many of us, he thinks that if the current push for reform doesn’t work, it will be a long, long time before anyone will ever touch it again.

His presentation is terrific; I’m going to resist the temptation to summarize it here, because I won’t do it justice AND because you should listen to the whole thing. Engage and enjoy!

A Frustrated Physician Speaks Out on on Town Halls, the Legislative Process, and the Urgent Need for Reform

August 18th, 2009 1 comment

An old college friend with whom I’ve recently reconnected sent me a long, thoughtful comment on my recent writings on health care. Since few read the comments (unless they are commenting themselves),  I’m posting Dr. James J. Ledwith’s thoughts on the need for health care reform here. Jim’s insights are informed by his years of practice in rural  Virginia and now in Boston. Wherever you stand on HC reform, this is a must read:

The Tea Party disruptions of public discussion of the health care reform probably won’t keep Congress from moving forward on this essential task, but it will compromise the quality of the final product by obstructing the open dialogue on the issues with our representatives. As a teaching family physician, I thought it was a good idea to send a medical student to a nearby town hall meeting with two of our congressmen. My student entered with a strong interest in the issues and concern for the impact on her plan to become a family physician, but left with a sense of frustration and embarrassment after Tea Party activists disrupted debate. Our Massachusetts representatives learned nothing to guide the shape of the new legislation.

Concerned by the hyperbole about rationing or pulling the plug? I suggest simply asking your physician how he or she would provide care for you. Concerned about unnecessary tests, or that your primary care specialist has no incentive to promptly read an ER report and talk to the limited-practice urologist who may need to perform a procedure to relieve the pain of a kidney stone? The physician practicing in a “Patient-Centered Medical Home” would do this but the service lacks funding outside of concierge practices for the elite. My prescription is to push Congress to begin reform of our health care system and build incentives to produce more family physicians, and that you hurry to establish care with one if you haven’t yet (Massachusetts has taught us that there are not enough primary care doctors to do the job).

The free market of private insurance simply doesn’t work in health care. There is no viable option for the low income worker, the individual with a pre-existing condition, or the guy who is laid off with COBRA premiums exceeding the unemployment check. There is no incentive for the young healthy worker to give up part of his income to insure himself until unexpected illness makes him a burden on public plans.

We all pay for the costs of the uncovered care and the travesty of having neighbors suffer rather than ask for assistance. A few years ago, nearly 1/5 of my patients in private practice in rural Virginia had no insurance to aid them with my bills, their medications, and consultations, let alone hospital care. Now in Massachusetts, it is a real pleasure, a relief actually, that due to Universal Coverage each visitor to my current office can afford to get the care I recommend.

We will have to make all insurance plans accountable to officials who answer to voting Americans. During nearly twenty years of small town family medicine, I was confronted by the need to push beyond standard procedures to appeal for coverage of necessary care with an insurer. At least a dozen or more times, my patients were fortunate to have a state rep on the state insurance commission. Minutes after calls to his office the coverage for the denied treatment was assured. By the way, this was necessary only with private insurers, not the public Medicaid or Medicare programs.

Private insurance plans have their place in the market with public plans, which are essential to offer help to those who need it. But should physicians spend valuable time sorting through varying coverage rules and limits for each individual patient? Care will be delivered efficiently to all with basic coverage for all, with uniform rules for all plans.

Remember, if a small minority obstructs sound civil debate, Americans who want to express views can still call and write to representatives individually or support lobbying groups who will rationally express those views.

How frustrating to have all of that experience drowned out by ignorance. A consequence of the First Amendment, I guess, but I think there’s a reasonable argument that shouting the other side down isn’t the kind of robust “debate” that the Founders had in mind. What’s the line between protected speech — however coarse — and destructive disruption? A few seem to be testing that line.