The 2010 Affordable Care Act represents a milestone in U.S. health care policy. The ACA moves the American health care system away, in important respects, from market-driven health care, including imposing new regulations on health insurers. Yet the ACA also relies, in other respects, on market forces to achieve its aims, including its embrace of health plan competition and high-deductible insurance. This article explores how the ACA balances liberal aspirations and market principles, and the implications for health reform implementation and (...) the future of U.S. health care. (shrink)

The American health care system long has been distinctive in its embrace of market forces. For-profit private insurers play a major role in providing coverage, though they operate alongside public insurance programs that cover over one-third of the population. Historically, federal and state governments’ regulation of insurance markets was limited, leaving insurers to set premiums and coverage rules largely as they saw fit.Government’s role in controlling health care spending has been even more circumscribed. Purchasing power is fragmented, with each insurer (...) negotiating its own rates with physicians and hospitals. A formidable medical-industrial complex of for-profit providers, from hospitals to home-health care agencies, dialysis facilities, pharmaceutical companies and much more, has arisen to sell services. (shrink)

This paper looks how health systems can go beyond clinical care to address the social determinants of health and considers why this approach might be particularly relevant for Accountable Care Organizations touted by the Affordable Care Act. ACOs make profits by reducing the medical expenses of patient populations. The leading causes of death in the United States are tobacco use, insufficient physical activity, and an unhealthy diet. These risk factors are linked to increased incidence of a wide range of chronic (...) diseases, the treatment of which places a tremendous financial burden on our health care system. Health care delivery and access are just a small part of the solution to our chronic disease crisis. Increasingly, strategies that address the social determinants of health —“the conditions into which people are born, grow, live, work, and age”— are the ones that hold the most promise. In Massachusetts, Steward Health Care System supports a number of initiatives to address the social determinants of health in its patient population. Steward provides an example of how a hospital system can address the health of its patient population by moving beyond clinical care. The varied initiatives have also resulted in cost savings for the system. (shrink)

The Affordable Care Act and other federal initiatives are fostering the emergence of a coherent vision for chronic disease prevention that has never before existed in the United States. This investment in population health and prevention comes not a moment too soon. Health care costs are proving very difficult to control and are rising at an unsustainable rate, driven in part by sky-rocketing chronic disease rates.This article looks at how a health system can engage in prevention activities beyond the clinical (...) setting and makes a strong case that these interventions will result in documented cost savings. We first examine an individually targeted strategy that helps patients obtain health insurance coverage. This strategy furthers a hospital's goal of receiving reimbursement for care while also having the social benefit of increasing patients’ economic stability. (shrink)

The American Journal of Bioethics, Volume 11, Issue 12, Page 17-20, December 2011.

As consumer lifestyles have changed over recent decades, people have increasingly turned to meals prepared away from home. A major consequence of this shift in eating patterns has been a concomitant rise in obesity rates worldwide. Research has consistently documented that consumers tend to make less healthy choices when purchasing prepared meals away from home. In part, this can be attributed to inadequate information at the time of purchase; both nutrition experts and lay consumers tend, for example, to underestimate calories (...) in food purchased away from home and thus portion sizes tend to be larger. Thus, by requiring restaurants and other purveyors of prepared foods to provide the calorie content and other nutrition information at the point of purchase, consumers should be able to make more informed decisions and public health should be improved. The often maligned Affordable Care Act (i.e., “Obamacare”) addressed this issue in a mandate calling for compulsory nutrition labeling of prepared foods at the point of sale. In response to this effort, conservatives in Congress introduced the “Common Sense Nutrition Disclosure Act” (CSNDA) which, if enacted, would have effectively eviscerated the menu labeling provisions mandated by the Affordable Care Act. The stated rationale behind this legislation: to protect small business and prevent job loss resulting from overly‐burdensome federal regulations. This article provides a historical look at the evolution of federally mandated menu labeling in the United States with particular emphasis on opposition to its passage. The position is taken such that this legislation is beneficial, warranted, and long overdue, and its opposition, as reflected in the CSNDA, points to the need for new metrics when evaluating public policy. (shrink)

In the heady days of 2011–2012, when Barack Obama was in his first term and the Patient Protection and Affordable Care Act heralded a golden future, medical anthropologists and activists had reason to be excited. Their country was about to take—so they believed—the greatest single step in the right direction since LBJ’s “Great Society” welfare spending program. It was in this climate that Inhorn and Wentzell’s collection of essays was published, and the optimism of the times shines through many of (...) the essays.The harsh reality is that at the end of 2012 Obama was re-elected, and after a painful deadlock the health insurance legislation known as “Obamacare” was pushed through. What followed has not turned out quite the way anyone expected and has driven an initial and unprecedented tidal wave of disapproval of the Obama presidency. Reading Medical Anthropology at the Intersections is therefore a sobering lesson in how a week can be a very long time in politics and a year a positive etern. (shrink)

The Trump Administration has exposed both the durability and vulnerability of the Patient Protection and Affordable Care Act's insurance reforms. One of the Administration's first strikes at “Obamacare” was to discontinue federal government payment of cost-sharing reductions, which insurers pay to low-income enrollees on the exchanges to reduce their out-of-pocket share of medical spending. The states struck back with a clever solution that could hold insurers and enrollees harmless. This article examines this strategy and why, while impressive, it reaffirms larger (...) problems with the ACA's market-based approach to health reform and the need for new pathways forward. (shrink)

This is part of a symposium on conscientious objection and religious freedom inspired by the US Catholic Church's claim that being forced to pay for health insurance that covers abortions (the effect of 'Obamacare')is the equivalent of forcing pacifists to fight. This article takes issue with this claim, and shows that while it would be unjust on democratic principles to force pacifists to fight, given their willingness to serve their country in other ways, there is no democratic objection to forcing (...) those who believe abortion to be murder to pay for health insurance coverage that includes abortion. (shrink)

Jungian psychology has taken a noticeable political turn in the recent years, and analysts and academics whose work draws on Jung’s ideas have made internationally recognised contributions in many humanitarian, communal and political contexts. This book brings together a multidisciplinary and international selection of contributors, all of whom have track records as activists, to discuss some of the most compelling issues in contemporary politics. Analysis and Activism is presented in six parts: Section One_, Interventions_, includes discussion of_ _what working outside (...) the consulting room means, and descriptions of work with displaced children in Colombia_, _projects for migrants in Italy and of an analyst’s engagement in the struggles of indigenous Australians. Section Two, _Equalities and Inequalities_, tackles topics ranging from the collapse of care systems in the UK to working with victims of torture. Section Three,_ Politics and Modernity_, looks at the struggles of native people in Guatemala and Canada and oral history interviews with members of the Chinese/Vietnamese diaspora. Section Four,_ Culture and Identity_, studies issues of race and class in Brazil, feminism and the gendered imagination, and the introduction of Obamacare in the USA. Section Five,_ Cultural Phantoms_, examines the continuing trauma of the Cultural Revolution in China, Jung’s relationship with Jews and Judaism, and German-Jewish dynamics. Finally, Section Six,_ Nature: Truth and Reconciliation_, looks at our broken connection to nature, town and country planning, and relief work after the 2011 earthquake in Japan. There remains throughout the book an acknowledgement that the project of thinking forward the political in Jungian psychology can be problematic, given Jung’s own questionable political history. What emerges is a radical and progressive Jungian approach to politics informed by the spirit of the times as well as by the spirit of the depths. This cutting-edge collection will be essential reading for Jungian and post-Jungian academics and analysts, psychotherapists, counsellors and psychologists, and academics and students of politics, sociology, psychosocial studies and cultural studies. (shrink)

The recent confirmation of the constitutionality of the Obama administration’s Patient Protection and Affordable Care Act (PPACA) by the US Supreme Court has brought to the fore long-standing debates over individual liberty and religious freedom. Advocates of personal liberty are often critical, particularly in the USA, of public health measures which they deem to be overly restrictive of personal choice. In addition to the alleged restrictions of individual freedom of choice when it comes to the question of whether or not (...) to purchase health insurance, opponents to the PPACA also argue that certain requirements of the Act violate the right to freedom of conscience by mandating support for services deemed immoral by religious groups. These issues continue the long running debate surrounding the demands of religious groups for special consideration in the realm of health care provision. In this paper I examine the requirements of the PPACA, and the impacts that religious, and other ideological, exemptions can have on public health, and argue that the exemptions provided for by the PPACA do not in fact impose unreasonable restrictions on religious freedom, but rather concede too much and in so doing endanger public health and some important individual liberties. (shrink)

We live with the legacy of injustice, political as well as personal. Even if our governments are now democratically elected and governed, our societies are scarred by forms of power and privilege accrued from a time in which people’s race, sex, class and religion were grounds for denying them a role in government, or in the selection of those who governed them. What does that past imply for the treatment of religion in democratic states? The problem is particularly pressing once (...) one accepts that religious freedom is not just a matter of individuals’ freedom of conscience and worship, but of people’s claims to associate with others through institutions whose powers, status and commitment to equality are very different (Laborde, 2015). If this means that churches pose some of the same philosophical and practical problems as families, from a democratic perspective, the fact that churches have no obvious point or justification, beyond being the repository of the claims to conscience of their members, appears to distinguish them from the former. In principle, this should make it easier to think about the claims of government, as compared to those of churches. In practice, however, it may simply bring into sharper focus philosophical and political challenges to equality that contemporary democracies now face. (shrink)