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Health Care Financing Reform: (5) The Wyden-Bennett Bill and "The Exchange"

By Wilson Huhn Published: August 31, 2009

     There are two fundamental approaches that lawmakers are considering to make health care more affordable and to give more persons access to health insurance coverage: (1) regulating the private market for health insurance to expand access and coverage and drive down costs, and (2) allowing people to purchase insurance from a government program similar to Medicare or Medicaid (the so-called "public option").   A key component to the first approach of regulating private health insurance is the "Exchange" or "Gateway."  Almost every proposal before Congress contains some variation of this idea.  Where the various plans differ is in whether participation in The Exchange would be voluntary or mandatory and the extent of regulation that insurance policies sold on The Exchange would be subject to.

    For example, Senators Ron Wyden of Oregon and Robert Bennett of Utah have proposed the Healthy Americans Act, which includes the "Free Choice Proposal."  This proposal would create "The Exchange," a state or national market for health insurance.  Under the Wyden-Bennett bill, individuals and employers could purchase health insurance on The Exchange.  Low-income persons would receive vouchers or subsidies to purchase insurance on The Exchange.  The money for these vouchers or subsidies would come from ending favorable tax treatment for employer-based health insurance - that is, by treating health insurance as if it were income for purposes of the income tax, and then granting low-income persons a tax credit for the difference.  Essentially, higher income employees would subsidize the purchase of health insurance for other persons.  I will provide more information about the Wyden-Bennett bill in tomorrow's posting.

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Top 10 law related websites

By Lynn Published: August 28, 2009

Here are some website lists you might find useful.

 1.   Top 10 Free Case Law Web Sites

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Health Care Financing Reform: (4) Should We Have Health Insurance?

By Wilson Huhn Published: August 28, 2009

     It may seem a little odd to have left this basic question for the fourth installment in this series, but should Americans have health insurance or should every individual or every family be on its own?  Should medical care always be paid for out-of-pocket?

     P.O.L. writes:

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Who Owns Corporations and Should They Pay For Access?

By Stefan Published: August 27, 2009

Question 1:  Who are the owners of the typical U.S. publicly traded corporation?

(a)  The shareholders.

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Health Care Financing Reform: (3) More on Costs

By Wilson Huhn Published: August 27, 2009

     In a previous posting I provided information about what I believe to be the single biggest reason why health care is more expensive in the United States than in other countries - administrative costs.  Over a quarter of the health care workers in America are administrators, and when you add in the sales, administrative costs, and profits of the private health insurance companies, it accounts for over 30% of all of the money that we spend on health care.  Here are other reasons for the high cost of medical care in the United States.

       In its report tracking the cost of health insurance premiums on a state-by-state basis, Family USA attributes the accelerating cost of health insurance premiums in the United States to four factors: (1) increased utilization, particularly as the American population becomes older and sicker; (2) lack of regulation of the health insurance industry; (3) consolidation among health insurance companies, resulting in "near monopoly power"; and (4) the growing cost of paying for the health care for uninsured Americans, which ultimately comes out of the pocket of those paying for health insurance.

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More Thoughts on the Torture Prosecution

By Wilson Huhn Published: August 26, 2009

     One of the persons who is dearest to me sent me a long critique of Eric Holder's decision to investigate whether or laws were broken when C.I.A. agents or contractors utilized unauthorized interrogation techniques.  My answer to this loved one is below.

Dear ____

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Torture Update: Inspector General Report, Special Prosecutor, and New Interrogation Unit

By Wilson Huhn Published: August 25, 2009

     Three significant events yesterday occurred yesterday on the torture front: the government released the 2004 C.I.A. Inspector General's Report on interrogations; Attorney General Eric Holder expanded the special prosecutor's jurisdiction to investigate whether interrogators broke the law; and it was revealed that the President has created a new single government unit to question "high value" prisoners in the war on terror.  More below.

     On Monday the administration released the May 7, 2004 report of the C.I.A. Inspector General entitled "Counterterrorism Detention and Interrogation Activities.  The report is over 100 pages long  and more than half of it is blacked out, its remaining contents still "top secret."  The most heavily edited portions of the report are those that describe how prisoners were treated.  Nearly everything on the use of waterboarding (pages 45 to 66 of the report) is blacked out. 

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Health Care Financing Reform: (2) Costs

By Wilson Huhn Published: August 24, 2009

     I thank the readers who posted comments to last Friday's entry about health care financing reform.  In this post I respond briefly to those comments, report on differing views about the causes of the high cost of medical care in the United States, and provide some links to informative sources on the subject.

     The cost of medical care in the United States is very high - approximately 17% of gross domestic product is attributed to health care, and this percentage is growing quickly.  On average, the cost of health care is increasing about twice as fast as inflation. 

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Health Care Financing Reform: (1) General Goals

By Wilson Huhn Published: August 21, 2009

     Over the next few weeks the national debate over reform of the system of paying for health care will intensify and its focus will sharpen as one or two bills emerge from House and Senate Committees and proceed to the floor of each chamber.  In today's posting I will briefly describe the goals that we all want to achieve, and in future postings I will describe the various proposals emerging from Congress and I will analyze the principal features of each bill.  I invite any questions or comments you may have about this critical issue facing our country. 

      There are three goals that everyone wants to achieve in reforming our nation's system of paying for health care.  We want medical care to be cheaper - we want it to be of higher quality - and we want everyone to be eligible to receive heath care.  All of us - liberals and conservatives, Democrats and Republicans, hope to reduce costs, improve quality, and expand access to medical care. 

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Just because you're paranoid . . . .

By Stefan Published: August 20, 2009

Fun weekly "coincidence":

First, Frank Rich (HT: Kristina Melomed) opines that:

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Panetta's Concern Revealed: Secret C.I.A-Blackwater Assassination Program

By Wilson Huhn Published: August 20, 2009

     In an article by Mark Mazzetti in yesterday's New York Times it was reported that the secret program that current C.I.A. Director Leon Panetta learned about, terminated, and revealed to Congress in June of 2009 was a Bush administration plan to use the Blackwater private security firm to help assassinate al-Qaeda leaders.

     In 1981 President Ronald Reagan issued Executive Order 12333 governing the administration of the intelligence services, Section 2.11 of which states:

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Tom Goldstein's Statistical Analysis of the Supreme Court Term

By Wilson Huhn Published: August 19, 2009

     Tom Goldstein of published a statistical analysis of the 2008-2009 Supreme Court term that can be accessed here.  Some of his findings are summarized and discussed below.

     Goldstein reports that the Supreme Court decided slightly more cases (79) during 2008-2009 than in recent years.  This is still about half the number of decisions that were regularly handed down each term two decades ago before William Rehnquist became Chief Justice.  In this 2006 article for the New York Times Linda Greenhouse describes this downward trend and offers some possible explanations, including the elimination of mandatory appeals, more agreement among the lower courts in the interpretation of the law, less congressional legislation to evaluate, and a reluctance among the justices to vote to hear a case that they might end up "losing."

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Nancy Beth Cruzan and the Constitutional Right to Refuse Medical Treatment

By Wilson Huhn Published: August 18, 2009

     The right to refuse lifesaving medical treatment as well as the wisdom of filling out advance directives was established in the case of Cruzan v. Director (1990).  This case is summarized below.

     In 1983 a young woman, Nancy Beth Cruzan, was seriously injured in an automobile accident and her brain was deprived of oxygen for several minutes.  Because she was in a comotose state the hospital inserted a gastrostomy tube into her stomach as a means of providing nutrition and hydration - a necessary step to take while physicians evaluated her condition.  Doctors eventually agreed that Nancy's higher brain functions had been destroyed and that there was no hope of recovery.  She was diagnosed as being in a "persistent vegetative state," a condition in which there is no possibility of conscious thought or even dreaming.  As a result her family requested that the gastrostomy tube should be removed so that Nancy could die, and they initiated a lawsuit on her behalf requesting a court order allowing the removal of the tube.  The Missouri trial court found that Nancy had a constitutional right to refuse medical treatment and that she would not have chosen to continue to leave the feeding tube in under these circumstances; it therefore ruled that the tube could be removed.  The decision was appealed by Nancy's guardian ad litem, and the Missouri Supreme Court reversed the decision of the trial court for two reasons: (1) The state supreme court expressed doubt that an individual has a constitutional right to refuse lifesaving medical treatment; and (2) the state supreme court ruled that under Missouri law the parents had the burden of producing "clear and convincing evidence" that Nancy would have chosen to discontinue treatment, and that the parents had failed to meet that standard in this case.

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Health Care Financing Reform and "Death Panels"

By Wilson Huhn Published: August 17, 2009

     Presented below is a summary of our options regarding reform of how to pay for health care and a brief discussion of the false rumors about "death panels" supposedly contained in the pending legislation.  In tomorrow's entry I will describe the constitutional right to refuse lifesaving medical treatment which was established in the case of Cruzan v. Director (1990).

     Almost everyone agrees that the cost of health care and health insurance is out of control and that we have to reform the way we pay for health care.  People disagree about how we should change the current system, and there must be a wide-ranging and open debate about what we are going to do to solve this complex problem.  Accordingly, it was surprising to me upon returning from vacation to learn that the country has recently been consumed with the false assertion that pending federal legislation would establish "death panels" that would have the power to force euthanasia.  This was a ridiculous charge, and it has diverted the country from confronting the difficult problem we face - how to pay for medical care. 

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Want to sue the government? There's a court for that!

By Lynn Published: August 14, 2009

Question: Isn't the government protected by immunity?
Answer:  Many actions are protected by sovereign immunity (also called civil immunity), but in 1975 the Ohio Court of Claims Act was passed creating the Ohio Court of Claims.   'The Court of Claims has original jurisdiction to hear and determine all civil actions filed against the state of Ohio and its agencies.'  The Court of Claims Act created a 'limited waiver' of immunity and permits certain types of law suits.  Source 

Question:  What kinds of law suits are now permitted? 
: Suits against officers and employees of the state:

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America the Beautiful: (10) A Breathtaking Tapestry

By Wilson Huhn Published: August 14, 2009

     America draws on threads from all cultures and attempts to weave them into a beautiful tapestry.  How glorious to be an American and to be able not simply to appreciate but to own a portion of each of these traditions.  The principle of tolerance extends to political and social values as well.

      America has a rich and varied national heritage, the most diverse of any nation in the world.  Not only does it make us unique - it makes us strong.  For instance, the marches of John Philip Sousa are right out of the traditions of Portugese band music.  But to fully appreciate American citizenship it is necessary to intentionally draw from this deep well of art and tradition.

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The Consumer Financial Protection Agency and the Problem of Freedom Versus Safety

By Stefan Published: August 13, 2009

James Kwak has an interesting post over at The Baseline Scenario describing the battle lines being drawn over the Consumer Financial Protection Agency (CFPA) as pitting outcomes against principles:

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America the Beautiful: (9) Constitutional Ideals in American Art

By Wilson Huhn Published: August 13, 2009

     There are countless works of art that reflect our constitutional ideals of liberty, fairness, and equality before the law.  I can only make a brief start on that list. 

     The greatest legal and social challenge we face as a nation is to overcome racial and ethnic hostility.  Some early works of art are worth studying because they give us insight into race hatred or notions of racial superiority.  "The Birth of a Nation" (1915)is deliberately malignant in its celebration of the rise of the Ku Klux Klan, while "Gone With the Wind" (1939) is thoughtlessly insensitive in its romanticized depiction of plantation life.  Even well-intentioned attempts at racial tolerance like Disney's "Song of the South" (1946) are difficult to watch today, but are still instructive of what our racial attitudes used to be.

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America the Beautiful: (8) Seeking Justice

By Wilson Huhn Published: August 12, 2009

     Consider the number of American television shows and movies about cops and robbers or that are centered on courtroom scenes.  America is fascinated with the battle between good and evil - and craves justice.

      The westerns described in the previous installment of this series often feature a heroic figure who confronts evil and who, through the reluctant use of force, defeats it.  In contrast, private and police detectives in countless shows like "Barnaby Jones," "Murder, She Wrote," or "C.S.I." use cunning and intelligence to unravel mysteries; that is the also the most prominent characteristic of police inspector Brenda Leigh Johnson of "The Closer" (my wife and I call the show "Confess, Dammit" and it took me awhile to remember the real name of it while writing this post.)  Courtroom dramas (Perry Mason, MatlockThe Verdict, My Cousin Vinnie) are another staple genre in American movies and television.  The enormously popular "Law and Order" franchise combines detective work with courtroom drama as brave and honest police and prosecutors "investigate crime and prosecute the offenders."

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America the Beautiful: (7) Into the West

By Wilson Huhn Published: August 11, 2009

     If you are about my age (59) try counting the number of "westerns" that appeared regularly on television when you were a child.  Why were there so many, and why aren't there any today?

     There was "Bonanza," "Gunsmoke," "Have Gun Will Travel," "Maverick," "Bat Masterson," "Cheyenne," "The Lone Ranger," "The Cisco Kid," "Cimarron City," "The Virginian," "Rawhide"  ... one website counts 146 western television series, and I watched an awful lot of them growing up.  The same site links to a list of 11,378 movies classified as "westerns."  In most of these shows the gun was an instrument of justice, and some of the television programs were simply named after guns: "The Rifleman," and "Colt 45."  Do you suppose that these shows have had an effect on our view of the Second Amendment?  But they have affected us in deeper ways as well.

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America the Beautiful: (6) Songs to American Cities

By Wilson Huhn Published: August 10, 2009

     There are a number of popular songs celebrating American cities, and they are very different from the "Home Sweet Home" songs set forth in Part 5 of this series.  Why should this be so?

     City songs tend to be up-tempo, rythmic tunes, with enthusiastic and optimistic lyrics.  My informal research would give the prize to the City of San Francisco for having the largest number of fantastic songs dedicated to it, including Otis Redding's haunting "Dock of the Bay," Tony Bennett's tearjerker "I Left My Heart in San Francisco," Scott McKenzie's hippie ballad "If You're Going to San Francisco," and Pete Seeger's savage "Little Boxes."  But my favorite is simply called "San Francisco" sung by Jeannette MacDonald from the 1936 movie of the same name starring her and Clark Gable.  Here is the rollicking chorus:

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The Anatomy of a Trial

By Lynn Published: August 7, 2009

Sometimes when I am helping library users, they ask for a 'simple' description of what happens in a trial.  Cases can get complicated very quickly and  if you are litigating your own case, you need to know what the next step is to prepare your case properly.  Today I am providing links to websites that describe the stages of a typical civil and criminal trial.  Some of the sites are from other state courts but are general enough that they still apply for Ohio.

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America the Beautiful: (5) Songs about Home Sweet Home

By Wilson Huhn Published: August 7, 2009

     Here are links to a number of famous American songs expressing longing for home.  Notice anything they have in common?

     Stephen Foster was the first great American songwriter, and among his many contributions to American culture are "Old Folks at Home (Suwanee River)" and "My Old Kentucky Home."  Here is Deanna Durbin's polished rendition of Suwannee River, and former Kentucky Governor and Baseball Commissioner "Happy" Chandler's amazing performance of "My Old Kentucky Home."     

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Overturning Stoneridge

By Stefan Published: August 6, 2009

Assume XYZ Corp. enters into sham agreements with ABC Corp. in order to bolster XYZ's bottom line.  Under the sham agreements, XYZ pays an additional $20 per widget purchased from ABC, and ABC then returns that $20 to XYZ under the guise of purchasing advertising.  XYZ then books the $20 as advertising revenue, creating the impression of a business that is thriving more than it actually is.  If you purchased XYZ stock during the period that its stock price was arguably inflated as a result of these sham transactions, should you be able to sue ABC (the firm on the other side of the sham transactions) for securities fraud under Section 10 of the Securities Exchange Act of 1934?  (Section 10 provides that:  "It shall be unlawful for any person, directly or indirectly . . . [t]o use or employ, in connection with the purchase or sale of any security . . . any manipulative or deceptive device.")  The Supreme Court of the United States said "no" in Stoneridge v. Scientific-Atlanta, but now Sen. Specter is introducing legislation to overturn that decision.  The proposed legislation is causing quite a stir and the battle lines seem nicely summed up as follows:

Dan Newman, a spokesman for the large plaintiffs firm Coughlin Stoia Geller Rudman & Robbins countered: 'For our economy and our financial markets to thrive, corporations must be held accountable when they commit fraud.'

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America the Beautiful: (4) Appalachian Culture

By Wilson Huhn Published: August 6, 2009

     Appalachian culture is quintessentially American, and it was produced by quintessentially American forces. 

     The mountains of West Virginia, eastern Kentucky, and eastern Tennessee were settled by proud, independent folk seeking to escape indentured servitude and the slave economy of the tidewater region.  People like Daniel Boone blazed trails and led their families into the high country, where they have maintained a distinctive culture to this day. 

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America the Beautiful: (3) Patriotic Songs

By Wilson Huhn Published: August 5, 2009

     For a young country we sure have a lot patriotic songs. 

     Here are links to two renditions of our National Anthem: (1) a classical arrangement by Whitney Houston at the Super Bowl, and (2) Jose Feliciano's original interpretation which met with such outrage in 1968 but which seems so heartfelt today.

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America the Beautiful: (2) Dvorak's New World Symphony

By Wilson Huhn Published: August 4, 2009

    Antonin Dvorak composed his 9th Symphony, "From the New World," during his visit to America in 1893.  It is one of the most beautiful works ever produced, chock full of unforgettable tunes and melodies.  America is honored to have inspired it and to have hosted its author during its composition.  Below are links to a production of the symphony by the Dublin Philharmonic Orchestra and to the song "Goin' Home" based on the second movement of the symphony.

First Movement, smooth, bright, and powerful - a stream that builds into a cascading river.

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America the Beautiful: (1) The New Colossus

By Wilson Huhn Published: August 3, 2009

     Two works of art, forever linked, express the American Dream - Bartholdi's statue "Liberty Enlightening the World" and Lazerus' poem "The New Colossus."  Please add your thoughts below. 


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