The public option "trigger" is receiving attention again. David Rogers of The Politico reports on a new policy paper issued by the Urban Institute recommending that health care reform not adopt a public option immediately, but rather allow the government health insurance plan to become effective only if health care costs contine to climb. There are both practical and political advantages to such a plan.
Referring to the Urban Institute study, Rogers states:
Mike Allen at The Politico has posted an article stating that Jonathan Gruber, an economist at MIT, has issued a report concluding that individuals will pay less for health insurance under the Senate health care reform bill, the Patient Protection and Affordable Health Care Act.
In two charts set forth on pages three and four of his report, Gruber compares the cost of non-group health insurance under current law and under the Senate bill. If no change is made to current law, Gruber finds that in the year 2016 the average cost of health insurance purchased through the non-group market will be $3,660 for an individual and $9,980 for a family of four. If the Senate bill is adopted creating health insurance exchanges with government subsidies for low-income persons, Gruber finds that individuals earning 175% of the Federal Poverty Level ($18,960 per year) will pay only $1,000 for health insurance - and even individuals earning 425% of the federal poverty level ($46,030) who receive no government subsidies will also pay less for health insurance - $3,460, or $200 less than they would under current law. A family of four, who would pay $9,980 under current law, would pay only $2,040 if their earnings are 175% of the poverty level ($38,530) and $9,380 at 425% of federal poverty level (earnings of $93,710 annually).To read more or comment...
Brandon Hensler of the American Civil Liberties Union recently posted an article on the A.C.L.U. Blog of Rights reporting that the Florida chapter has filed a federal lawsuit on behalf of public school students who wore tee-shirts to school and to a football game stating "Islam is of the Devil." Do public school students have a constitutional right to insult other people's religions in this manner?
Hensler reports that a group of public school students who were members of the Dove World Outreach Center, a Christian church in Gainesville, Florida wore message shirts to their schools (elementary through high school) celebrating their own faith and denigrating another one. On the front of the shirt were two positive messages: "Jesus answered 'I am the way and the truth and the life; no one goes to the Father except through me; and 'I stand with Dove World Outreach Center." On the back of the shirt was the message "Islam is of the Devil."To read more or comment...
The following organizations provide legal information about and advocacy on behalf of constitutional issues. Self-descriptions for each organization are provided in quotes.
Alliance for Justice - "Alliance for Justice is a national association of environmental, civil rights, mental health, women's, children's, and consumer advocacy organizations. Since its inception in 1979, AFJ has worked to advance the cause of justice for all Americans, strengthen the public interest community's ability to influence public policy, and foster the next generation of advocates."
The report compares the two bills with respect to their overall approach to health care financing reform, the individual mandate to purchase insurance, employer requirements to either provide insurance or pay a fee, the expansion of Medicaid and CHIP, health insurance premium subsidies to individuals and employers, tax changes, insurance pooling mechanisms, design of health insurance benefits, other changes to private health insurance plans, the role of the states in managing insurance exchanges and regulating the health insurance industry, cost containment mechanisms, programs for improving the quality of medical care, programs for fostering preventive care and wellness, provision for voluntary long-term care insurance, additional spending on Medicare and physician training, and how each bill is financed.To read more or comment...
Absent the threat of a filibuster, health care reform would already have been enacted into law. Are filibusters constitutional?
By itself, the "filibuster" is nothing more than an attempt to wear down the opposition through endless debate. It is an annoying tactic whenever it is used by family members or workmates. When employed in the public realm it elevates the wishes of the minority over the rights of the majority.To read more or comment...
Over at the Wall Street Journal, James Stewart is giving thanks for Ben Bernanke and Tim Geithner:
So, while I remain uncomfortable with the "bankers watching bankers" aspect of our central banking system--today I join Mr. Stewart in giving thanks for Ben Bernanke and Tim Geithner. I reserve the right to change my mind. I remain concerned about the apparent recovery's failure to trickle down to consumers, home owners, and workers. I favor serious examination of our central banking system and am open to new regulation (though the devil is, as almost always, in the details). But I am grateful we avoided "Great Depression II".To read more or comment...
The Constitution contains two provisions protecting freedom of religion: the Establishment Clause and the Free Exercise Clause. There are many situations where these two clauses conflict. Cases where students wish to speak about their religion at graduation is one of those situations.
Two cases involving religious speech at high school graduations were appealed to the Supreme Court this year: McComb v. Crehan (No. 08-1566) (out of Florida) and Corder v. Lewis-Palmer School District (No. 09-257) (out of Colorado). The Supreme Court recently decided not to hear the Nevada case. It has not yet decided whether to hear the appeal of the Colorado student.To read more or comment...
One of the principal cost-cutting reforms that both the House and the Senate health care bills would enact is to reduce unnecessary spending on Medicare Advantage. This is explained below.
Ezra Klein of the Washington Post described the problem with Medicare Advantage in an article that he posted on October 15. He stated:
In September of 2009 the Brookings Institute issued a study entitled "Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth." I apologize for overlooking this report until now. The recommendations from the report are set forth below.
It has been estimated that the Democratic bills pending before the House and Senate will extend quality health insurance coverage to millions of Americans who are currently uninsured or underinsured and will reduce the federal deficit, but the Democratic plans will do nothing to limit the growth in the overall cost of medical care, which is expected to double over the next ten years. The Republican plan will do almost nothing to help the uninsured and underinsured, and it will have only a slight effect on containing costs - it is estimated that instead of doubling over the next ten years, under the Republican plan costs will go up by "only" 90%.To read more or comment...
The Senate voted 60-39 this evening to cut off a filibuster, thus allowing debate on the health care bill that is pending in the Senate, the Patient Protection and Affordable Health Care Act. Links to news stories below.
To read more or comment...
Judge Stephen Reinhardt of the Ninth Circuit Court of Appeals has found a key provision of the Defense of Marriage Act unconstitutional.
Judge Stephen Reinhardt issued a ruling Wednesday in the case of In the Matter of Brad Levenson in which he declared that a key provision of the Defense of Marrriage Act (DOMA) is unconstitutional.To read more or comment...
Yoani Sanchez, a courageous Cuban blogger, reports in the Huffington Post that President Obama responded to seven questions that she had posed to him. More below.
On November 6, Juan O. Tamayo of the Miami Herald reported that Yoani Sanchez was detained and beaten by Cuban state security officials while on her way to a march against violence. On November 18, in an article posted by the Huffington Post, Sanchez revealed that she had submitted six questions to Raul Castro, President of Cuba, and seven questions to Barack Obama, President of the United States. Here are the questions she asked President Obama:
In today's Wall Street Journal, there is an interview with Prof. Daylian Cain of the Yale School of Management. Prof. Cain teaches a course entitled, "Business Ethics Meets Behavioral Economics." In the interview, Prof. Cain states that: "Behavioral economics is such a great tool because it shows how people make bad decisions and separate their actions from their values." In other words, you can be really smart and have really great values and still make terrible mistakes because you are not the perfectly rational actor of classical economics who lives in a world where all the messy realities of life are assumed away.
Perhaps some of this insight is implicated by today's post by Prof. Lawrence Cunningham over at Concurring Opinions (HT: Kristina Melomed). Prof. Cunningham recounts that:
Hallelujah! Senate Majority Leader Reid (D-NV) has released the "Patient Protection and Affordable Health Care Act" - his melding of the health care reform bills that had been approved by the Senate Finance Committee and the Senate HELP Committee. In addition, the Congressional Budget Office has released its estimate of the effect of the bill on the federal budget. Details below.
First of all, this is a massive bill. It is over 2000 pages long - the table of contents alone is 13 pages long. It is going to take some time to cover all of the changes that this bill will make to the system of medical care and how we pay for it. Today's posting is only a start.To read more or comment...
The United States Preventive Services Task Force has issued recommendations against using mammograms for routine screening for breast cancer among women 40-49, and recommends screening only every two years after age 50. What timing!
To read more or comment...
Earlier today the Supreme Court announced that it would not hear the case that had been brought against the owners of the Washington Redskins football team challenging their use of the name "Redskins" as a trademark. The issue in the case was not the First Amendment or even the substance of Trademark Law; instead, the issue was whether the plaintiffs had brought their lawsuit in time, or whether it was barred by the doctrine of "laches."
In 1967 the corporation that owns the Washington Redskins football team applied for and was granted a trademark for the name "Redskins." Section 2 of the Trademark Act (15 U.S.C. 1052) specifically prohibits the registration of a trademark that is "scandalous" or that is "disparaging" towards persons, living or dead, or that brings them into "contempt" or "disrepute." The law states:
The Business Roundtable has issued an enlightening and informative report on health care financing reform. The Roundtable is concerned primarily with reducing the cost of health care, not with expanding coverage to the uninsured. The Roundtable's position and the contents of the report are summarized below.
The Business Roundtable describes itself as follows:
The Centers for Medicaid and Medicare Services has released its report on the effect of H.R. 3962, the health care reform bill adopted by the House of Representatives. There is very good news and very bad news.
Here is a link to the full report, "Estimated Financial Effects of the 'America's Affordable Health Choices Act of 2009 (H.R. 3962), as Passed by the House on November 7, 2009," and here is a summary of the report.To read more or comment...
Attorney General Eric Holder has decided to try five prisoners in the war on terror, including Khalid Sheikh Mohammed, on criminal charges in New York for the attacks of September 11. They will face the death penalty.
Yesterday Attorney General Eric Holder released a statement in which he said:
According to a recent summary from the Congressional Budget Office, because our population is becoming older and sicker spending on Social Security, Medicare, and Medicaid is set to explode and the resulting mountain of debt will overwhelm us. Here are the depressing statistics.
The CBO has posted a slideshow of charts entitled "Aging and Health: The Challenges of Entitlement Growth." I would rate this report "not suitable for children" - not because of sex, violence, or bad language, but because of the despair it may engender in them for our country's future.To read more or comment...
On November 2, the U.S. General Accountability Office (GAO) released a report analyzing the Dept. of Defense's ability to drawdown (or withdrawal) U.S. Forces from Iraq. Troop withdrawal plans are based on the U.S.-Iraq Security Agreement signed in 2008 (support by President Obama here ) and intend to reduce to 50,000 troops by August 2010 and be completely withdrawn by the end of 2011. This task is daunting and means the drawdown of 128,700 U.S. troops, 115,000 contractors, closing 295 bases and the retrograde of over 3.3 million pieces of U.S. DOD equipment in Iraq worth $45.8 billion. Can the DOD meet the timeline set by the President and the U.S.-Iraq Security Agreement? The GAO took a look.
The U.S. General Accountability Office is considered a watchdog agency that examines the use of public funds; evaluates federal programs and policies; and provides analyses, recommendations and other assistance to help Congress and the President make decisions. The following are problems that the GAO identified as impeding the phased withdrawal of U.S. troops from Iraq. More details about each are found in the report.
The University of Akron School of Law Center for Intellectual Property Law and Technology will host a lecture by Jacqueline Lipton, professor of law at Case Western Reserve University. The lecture, which is free and open to the public, is titled 'Mapping Online Privacy' and will be held Wednesday, Nov. 18 at 5 p.m. in Room 152 at The University of Akron School of Law, 150 University Ave., Akron, Ohio. A reception will immediately follow the lecture.
Lipton's lecture will address the difficulties in applying existing concepts of personal privacy to the maturing Internet. With Web 2.0 technologies, more people have more opportunities to post information about themselves and others online, often with scant regard for individual privacy. Shifting notions of 'reasonable expectations of privacy' in the context of blogs, wikis, and online social networks create challenges for privacy regulation. Courts and commentators struggle with Web 2.0 privacy incursions without the benefit of a clear regulatory framework.To read more or comment...
In yesterday's post I described how there appears to broad support in favor of enacting ENDA - the law that will prohibit employment discrimination on the basis of sexual orientation and gender identity. In this post I sketch out the provisions of the proposed federal law.
The heart of the bill is Section 4(a), which provides:
A couple of weeks ago I blogged about the pending criminal trial of former Bear Stearns executives Ralph Cioffi and Matthew Tannin on charges they defrauded investors in connection with the failure of their hedge funds. While I did not agree with those who characterized the case as one of "spin versus fraud", I did believe the prosecution would have a hard time proving criminal intent. Apparently, the jury concurred because Cioffi and Tannin were acquitted this past Tuesday by a "jury of mostly working class Americans." Now, the question becomes how much steam the government has left to pursue criminal convictions against other executives tied to the financial crisis--like some of those at AIG and Lehman. Sorting that out will involve determining how much of what went wrong for the prosecution in this case is limited to its particular facts. Here's a short list of possible explanations for why the jury sided with the defense:
The Employment Non-Discrimination Act (ENDA), which would prohibit employment discrimination on the basis of sexual orientation or gender identity is moving through both houses of Congress. A similar law in Salt Lake City picked up unexpected support from the Church of Latter-Day Saints.
The federal Employment Non-Discrimination Act, which would ban employment discrimination against gays, lesbians, bisexuals, and transgender people, has been introduced in Congress with broad bipartisan support. Here is some background on the bill from the Human Rights Campaign. In the House, Rep. Barney Frank (D-MA) has introduced H.R. 3017, which has 189 co-sponsors, and in the Senate, Sen. Jeff Merkley (D-OR), has introduced S. 1584, which has 43 c0-sponsors. On November 5 the Senate Health, Education, Labor, and Pensions Committee held a hearing on S. 1584. The Chair of the Committee, Senator Tom Harkin (D-IA), released a statement which commences with these words:
The Commonwealth Fund surveyed thousands of primary care physicians from several industrialized countries. The findings help to explain why Americans pay so much more for health care but somehow have worse health than the people of other countries.
The study surveyed 10,000 primary care physicians from 11 countries: Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States. Among the most significant findings in the survey were that:
The following post comes from Prof. Jay Dratler, Jr.:
The case of Bilski v. Kappos, argued yesterday before the Supreme Court, 2009 Term, No. 08-964, addresses a question vital to the survival of our free enterprise system. (Number citations are to pages and lines of the oral argument transcript.)To read more or comment...
The enactment of the Stupak Amendment as part of the health care bill reawakens the debate over abortion. Both sides invoke arguments by analogy in support of their positions on abortion and abortion funding. I find a third analogy to be more fitting - one that supports the Supreme Court's position that while abortion is fundamental right, abortion funding is not.
In arguing against restrictions on abortion funding like the Hyde Amendment or the Stupak Amendment people who are pro-choice are prone to draw an analogy between abortion and war. They contend that because every citizen may be compelled to contribute his or her tax dollars towards the prosecution of wars that they may be opposed to - wars that they consider to be unjust or immoral - accordingly, those who are opposed to abortion should be compelled to pay for the abortion procedure through their tax dollars.To read more or comment...
This posting contains a description of the Stupak Amendment restricting the use of federal funds to pay for abortions and links to articles and sites discussing the amendment.
Last night the House adopted an amendment sponsored by Bart Stupak (D-MI) prohibiting the use of federal funds for purchasing health insurance covering abortion. This amendment was made a part of H.R. 3962 just before that landmark bill was enacted by the House of Representatives. According to an article by Patrick O'Connor at The Politico, the inclusion of the amendment secured the support of the United States Conference of Catholic Bishops for the entire health care bill. As it turned out, the amendment was necessary to obtain passage of the bill - 64 Democrats voted for the amendment, without whom the larger bill would not have come close to passage.To read more or comment...
My wife and I stayed up late last night (OK, I stayed up late - she does not consider 11:30 p.m. to be late) to watch the House of Representatives adopt H.R. 3962, The Affordable Health Choices Act of 2009. Here is my bottom line on the bill.
The bill achieves nearly universal coverage by requiring people to have health insurance, by subsidizing its purchase by low income persons, and by requiring insurance companies to insure people regardless of any preexisting medical conditions. According to the CBO, once the law is fully effective, 96% of Americans will have health insurance coverage (as opposed to only 83% of Americans under current law). In addition, the bill addresses the problem of people being underinsured. People with health insurance will have more comprehensive coverage than they do today, covering virtually all medical conditions except abortion. (More on that in the next installment of this series, Number 62, concerning the Stupak Amendment).To read more or comment...
This posting compares the tort reform provisions of the Democratic and Republican health care bills which are pending in the House of Representatives.
The civil litigation system fails us in several important respects in medical cases. First of all, because of the extraordinary expense of bringing one of these cases, only the most serious claims have even a chance of being redressed. If you miss a month of work because of injury resulting from medical malpractice or a faulty medical device and you have some lingering pain no responsible attorney will do more than write a letter on your behalf. It costs money to hire experts and depose witnesses, and small or even medium-size claims are never litigated.To read more or comment...
In the comments to Posting Number 55 of this series Quidpro and Dan S. debate what the effect of health care financing reform legislation will be on physicians and the willingness of persons to enter or stay in the medical profession. We will learn more over the weekend as doctors debate whether to ratify AMA support for the House Democratic bill.
Yesterday the AMA announced that it would support the House Democratic bill, the Affordable Health Choices Act of 2009 (H.R. 3962). James Rohack, AMA President, stated:
One of the most divisive questions in health care financing reform involves funding for abortions. Pro-life House Democrats have threatened to vote against the House Democratic bill, H.R. 3962, unless it is amended to ensure that federal funds are not spent on abortions. A member of this group, Rep. Brad Ellsworth (D-IN), has proposed an amendment to the House Democratic bill.
On November 3 Representative Ellsworth issued a statement announcing his proposal. He stated:
The Republican Party in the House of Representatives has offered an alternative to the Democratic health care financing reform bill. This posting contains links to the bill and to CBO scoring of it, and a very preliminary analysis of the bill.
Here is the Common Sense Health Care Reform and Affordability Act unveiled by Minority Leader John Boehner (R-OH) and the House Republicans late last night. Here is theNovember 4, 2009, CBO report scoring the bill. For purposes of comparison, here is the House Democratic bill, the Affordable Health Choices Act of 2009 (H.R. 3962) and the October 29, 2009, CBO report scoring that bill.To read more or comment...
Voters in Maine and Washington State voted yesterday in referenda on whether to approve or disapprove laws that had been adopted by their state legislatures relating to the recognition of same-sex unions. In Maine, the voters decided to reject a law that would have recognized same-sex marriage. In Washington State the voters ratified a domestic partnership law that grants same-sex couples the same legal rights as married couples.
According to an article by Kevin Miller and Judy Harrison of the Bangor Daily News, by a margin of 53-47 % voters in Maine have chosen to reject the state's same-sex marriage law. There was popular support for same-sex marriage in cities such as Portland and Bangor, but this was overcome by votes from rural areas of the state and Roman Catholic / Franco-American regions.To read more or comment...
Senators representing rural states and members of Congress from rural districts support legislation that would increase revenues for rural hospitals. (Dog bites man!)
Eric Pianin and Mary Agnes Carey, in an informative article written for Kaiser Health News, describe how lawmakers from rural states and congressional districts are attempting to direct extra Medicare revenues towards rural hospitals by having those institutions designated as "Critical Access Hospitals." The designation "critical access" was originally intended to offer support to a few dozen small rural institutions that were more than 35 miles away from any other hospital and which would serve mainly as transport points - patients who were seriously injured or ill would be stabilized at these access points and transferred to larger hospitals. The program has evolved to the point that one-fifth of all of the hospitals in the United States are now designated "critical access hospitals," entitling them to additional Medicare funding. These hospitals don't simply transport seriously ill patients - they treat them, thus injecting money into local economies. Lawmakers representing rural areas want to increase the numbers of these hospitals and allow them to grow larger and still qualify for extra funding. Pianin and Carey identify Mark Pryor (D-AR), Sam Brownback (R-KS), and Ron Wyden (D-OR) as seeking an expansion of this program.To read more or comment...
According to a report by the Congressional Budget Office, H.R. 3962, the bill that Speaker Nancy Pelosi brought to the House floor last week costs $343 billion less than the bill that it replaced, H.R. 3200. How was this accomplished?
Here is the CBO report on the new House bill, H.R. 3962, and here is the CBO report for the previous version of the House bill, H.R. 3200. The new bill extends insurance coverage to 36 million people who are currently uninsured (a million fewer people than the previous bill) and, like the previous bill, it upgrades the insurance coverage of every American by prohibiting exclusions for preexisting conditions, abolishing lifetime limits in coverage, and requiring total coverage for preventive care.To read more or comment...
Any health care reform legislation seeking to reduce cost, broaden access, and improve quality must address the promise and the expense of biologic drugs. A debate has erupted over the best way to encourage research and production of these drugs while at the same time making them broadly available to the people who need them.
The National Cancer Institute defines "biologic drug" as: