Health care costs and affordability are critical issues to consumers. Just as we assess the coverage impacts of a health reform proposal, we should be able to evaluate how the plan will constrain health care costs: its theory of cost control. This essay provides a framework to assess health reform plans on their theories of cost control, identifying the key policy tools to constrain health care costs organized in a two-by-two matrix across the following dimensions: price vs. utilization and public (...) vs. private payers. It then applies the framework to the Affordable Care Act and the Republican's 2017 legislative efforts to repeal and replace the ACA to identify their general theories of cost control, revealing on the plans' strengths, blind spots, and incoherence. (shrink)
Despite historic efforts to enact the Patient Protection and Affordable Care Act in 2010, national health reform is threatened by multiple legal challenges grounded in constitutional law. Premier among these claims is the premise that PPACA’s “individual mandate” is constitutionally infirm. Attorneys General in Virginia and Florida allege that Congress’ interstate commerce powers do not authorize federal imposition of the individual mandate because Congress lacks the power to regulate commercial “inactivity.” Stated simply, Congress cannot regulate individuals who choose not to (...) obtain health insurance because they are not engaged in a commercial venture. Several courts initially considering this argument have rejected it, but two federal district courts in Virginia and Florida have concurred, leading to numerous appeals and the near promise of United States Supreme Court review. (shrink)
Among multiple legal challenges to the Patient Protection and Affordable Care Act (PPACA) is the premise that PPACA's “individual mandate” (requiring all individuals to obtain health insurance by 2014 or face civil penalties) is inviolate of Congress' interstate commerce powers because Congress lacks the power to regulate commercial “inactivity.” Several courts initially considering this argument have rejected it, but federal district courts in Virginia and Florida have concurred, leading to numerous appeals and prospective review of the United States Supreme Court. (...) Despite creative arguments, the dispositive constitutional question is not whether Congress' interstate commerce power extends to commercial inactivity. Rather, it is whether Congress may regulate individual decisions with significant economic ramifications in the interests of protecting and promoting the public's health. This article offers a counter-interpretation of the scope of Congress' interstate commerce power to regulate in furtherance of the public's health. (shrink)
The ACA shifted U.S. health policy from centering on principles of actuarial fairness toward social solidarity. Yet four legal fixtures of the health care system have prevented the achievement of social solidarity: federalism, fiscal pluralism, privatization, and individualism. Future reforms must confront these fixtures to realize social solidarity in health care, American-style.
Out-of-network air ambulance bills are a pernicious and financially devastating type of surprise medical bill. Courts have broadly interpreted the Airline Deregulation Act to preempt most state attempts to regulate air ambulance billing abuses, so a federal solution is ultimately needed. However, in the absence of a federal fix, states have experimented with a variety of approaches that may survive preemption and provide some protections for their citizens.
Researchers now commonly collect biospecimens for genomic analysis together with information from mobile devices and electronic health records. This rich combination of data creates new opportunities for understanding and addressing important health issues, but also intensifies challenges to privacy and confidentiality. Here, we elucidate the “web” of legal protections for precision medicine research by integrating findings from qualitative interviews with structured legal research and applying them to realistic research scenarios involving various privacy threats.
There is one sound that will always be loudest in sports. It isn’t the squeak of sneakers or the crunch of helmets; it isn’t the grunts or even the stadium music. It’s the deafening roar of sports fans. For those few among us on the outside, sports fandom—with its war paint and pennants, its pricey cable TV packages and esoteric stats reeled off like code—looks highly irrational, entertainment gone overboard. But as Erin C. Tarver demonstrates in this book, sports (...) fandom has become extraordinarily important to our psyche, a matter of the very essence of who we are. Why in the world, Tarver asks, would anyone care about how well a total stranger can throw a ball, or hit one with a bat, or toss one through a hoop? Because such activities and the massive public events that surround them form some of the most meaningful ritual identity practices we have today. They are a primary way we—as individuals and a collective—decide both who we are who we are not. And as such, they are also one of the key ways that various social structures—such as race and gender hierarchies—are sustained, lending a dark side to the joys of being a sports fan. Drawing on everything from philosophy to sociology to sports history, she offers a profound exploration of the significance of sports in contemporary life, showing us just how high the stakes of the game are. (shrink)
While people’s lives continue to be put at risk by the dearth of organs available for transplantation, we must give urgent consideration to any option that may make up the shortfall. A market in organs from living donors is one such option. The market should be ethically supportable, and have built into it, for example, safeguards against wrongful exploitation. This can be accomplished by establishing a single purchaser system within a confined marketplace.Statistics can be dehumanising. The following numbers, however, have (...) more impact than most: as of 24th November, during 2002 in the United Kingdom, 667 people have donated organs, 2055 people have received transplants, and 5615 people are still awaiting transplants.1 It is difficult to estimate how many people die prematurely for want of donor organs. “In the world as a whole there are an estimated 700 000 patients on dialysis . . . . In India alone 100 000 new patients present with kidney failure each year”2 . Almost “three million Americans suffer from congestive heart failure . . . deaths related to this condition are estimated at 250 000 each year . . . …. (shrink)
Human traffickers use various methods to maintain and control their victims, including physical, economic, and psychological restraints. Specifically focusing on the psychological aspect of control, this paper seeks to address the role of religion and how it can be exploited as a tool of coercion. Employing case study methodology, this paper will focus on examples of Islam, House of Judah, and Scientology, and how belief systems facilitated victim coercion. The purpose is threefold: to establish religion as a tool of coercion (...) at the interpersonal level, to examine specific trafficking cases in which religion was the method of coercion, and to discuss the challenge of prosecuting cases in which the act was the result of religious coercion. (shrink)
The placenta invades the adjacent uterus and controls the maternal immune system, like a cancer invades surrounding organs and suppresses the local immune response. Intriguingly, placental and cancer cells are globally hypomethylated and share an epigenetic phenomenon that is not well understood – they fail to silence repetitive DNA sequences that are silenced in healthy somatic cells. In the placenta, hypomethylation of retrotransposons has facilitated the evolution of new genes essential for placental function. In cancer, hypomethylation is thought to contribute (...) to activation of oncogenes, genomic instability, and retrotransposon unsilencing; the latter, we postulate, is possibly the most important consequence. Activation of placental retrotransposon-derived genes in cancer underpins our hypothesis that hypomethylation of these genes drives cancer cell invasion. This alludes to an interesting paradox, that while placental retrotransposon-derived genes are essential for promoting early hominid life, the same genes promote disease-susceptibility and death through cancer. Placental and cancer cells fail to silence retrotransposons that are normally silenced in healthy tissues. This has created new genes that are essential for placental function, yet they are also expressed in cancer. We hypothesize that active retrotransposons are a double-edged sword, contributing both adaptive and deleterious functions to biology. (shrink)
Janet Radcliffe Richards is as always to the point and radical. We agree with her that “if it is presumptively bad to prevent sales altogether because lives will be lost . . . it is for the same reason presumptively bad to restrict the selling of organs”. Her complaint against our paper is that we are unnecessarily restrictive. John Harris indeed has argued that there are no sound ethical or philosophical reasons for objecting on principle to the sale of live (...) tissue and organs.1 If a scheme can be devised …. (shrink)
An account of the specific ill of Native American mascots—that is, the particular racism of using Native Americans as mascots, as distinct from other racist portrayals of Native Americans—requires a fuller account of the function of mascots as such than has previously been offered. By analyzing the history of mascots in the United States, this article argues that mascots function as symbols that draw into an artificial unity 1) a variety of teams existing over a period of time and thereby (...) 2) a community of individuals who are thus able to use that team as their own symbolic locus of unification.This unification of teams and their concomitant communities is accomplished by appeal to a symbol that facilitates a particular fantasy of collective identity. The usage of Native American mascots is racist not only because it involves stereotypical portrayals of Native Americans, but (more specifically) because it treats Native persons simply as a means to symbolic unification—and not, importantly, as members of the community they thus serve. In other words, in these cases mascots work as unifying signifiers precisely by being the purely instrumental facilitator of a group's collective fantasy of itself. (shrink)
Judith Butler’s influential work in feminist theory is significant for its insight that sexist discourse in popular culture affects the agency and consciousness of individuals, but offers an inadequate account of how such discourse might be said to touch, shape, or affect selves. Supplementing Butler’s account of signification with a Deweyan pragmatic account of meaning-making and selective emphasis enables a consistent account of the relationship between discourse and subjectivity with a robust conception of the bodily organism. An analysis of the (...) popular discourse surrounding Hillary Clinton in the 2008 Presidential campaign demonstrates why this hybrid pragmatic/poststructuralist account is necessary. (shrink)
Some provisions of the UN’s Convention on the Elimination of Discrimination Against Women (CEDAW) are clearly important from the perspective of business ethics, particularly those calling for equal rights for women to employment and financial security. Some other provisions of CEDAW are equally as important for ethical business practices and Corporate Social Responsibility (CSR), but are frequently overlooked because of the presumption that they are not strictly business concerns: the rights of women to participation in public life, marriage, and family (...) rights; the rights of rural women to adequate living conditions; and general rights to equality. This chapter will discuss the conceptual commitments that underlie the assumption of a clear demarcation between work and life concerns, and examine the criticisms of this assumption made by feminism. It will, in particular, be interested in: -/- • The public/private distinction • The meaning of “work” or “labor” • The relationship between CSR and care ethics • Fostering a broader understanding of the family or familial relations • Examining the connection between fair wages and work/life integration -/- These discussions suggest that the ability for businesses worldwide to uphold the tenets of CEDAW is dependent upon a reconsideration of the character of the Ideal Worker and a nuanced understanding of the effects of workplace policies on the wider communities in which businesses operate. In particular, though work/life integration is not strictly speaking a “women’s issue,” the ethical and policy considerations addressed herein currently have disproportionately negative effects for women; thus, addressing them is crucial for achieving the aims of gender equality. (shrink)
It is difficult for us to effectively diagnose our current character state such that we can follow Aristotle's advice to aim for the opposite extreme. The law can provide us a general standard, and the household strives to fill in the particular gaps inevitable to laws that must be universal. Neither, however, can ensure a proper diagnosis. Careful attention to Aristotle's discussion of how the medical doctor generates health gives us a model we can apply to Aristotle's discussions of character (...) virtues and vices in Book IV of Nicomachean Ethics. The medical doctor must identify the form of health and its various lacks, must have a sufficiently varied set of images by which to properly grasp these in the varied context of human beings, must attend carefully to the patient's impeded form of health, and must trace this impediment back to some cause on the basis of which she can act to correct the problem. By applying this model, we can more profitably employ Aristotle's discussions of individual virtues in our responsible attempts to diagnose and heal the characters of those who belong to us. (shrink)
in 2017, a study of the brains of former football players returned some of the most damning evidence to date of the inherent dangers of the game. Of 111 former NFL players' brains examined post-mortem, 110 were found to have the damage associated with chronic traumatic encephalopathy, a brain disease causing serious emotional and behavioral problems—and, often, premature death. That football is physically risky has been known virtually since its advent; what the newest studies suggest is that its dangers are (...) much more extensive than previously imagined, and much harder to avoid than had been hoped.Such findings add urgency to the ethical problems that football raises: How can one justify... (shrink)
ABSTRACT Understanding many white football fans' responses to football players' protests against police brutality requires recognizing the historical and contemporary role of football fandom in managing racial and gendered anxieties. In this article, I analyze three distinct uses of memory by white football fans as they work through the anxiety that results when the sport fails to work in the way they expect. My analysis draws on the opposing views of football taken by the American philosophers Josiah Royce and George (...) Santayana and on contemporary social science research on the behavior of sports fans. I show that contemporary fan hostility to protesting players is consistent with the social ills that have surrounded football since the era of Royce's critique. (shrink)
Taking seriously Linda Martín Alcoff's suggestion that we reevaluate the extent to which poststructuralist articulations of the subject are truly socially constituted, as well as the centrality of Latina identity to her own account of such constitution, I argue that the discussion Alcoff and other Latina feminists offer of the experience of being Latina in North America is illustrative of the extent to which the relational and globally situated constitution of subjects needs further development in many social-constructionist accounts of selfhood. (...) I argue, however—contra Alcoff—that Michel Foucault's mode of investigating subjectivation, particularly as it is articulated in his later work, has room for just such an account, especially when it is supplemented by postcolonial theory. With this end in mind, I take as a case study the public discourse surrounding Sonia Sotomayor prior to her confirmation as the first Latina woman to serve on the United States Supreme Court, suggesting that an analysis of this discourse (including its position within and contribution to wider discourses of ethnicity, race, gender, and class) shows why the accounts of relational subject-constitution offered by both Foucault and Alcoff are indispensable. (shrink)
In Pragmatism as Transition, Colin Koopman argues for a vision of pragmatism that is at once old and new, seeking to overcome the divide between classicopragmatism and neo-pragmatism through a vision of pragmatism whose central feature is “transitionalism.” Transitionalism, for Koopman, is a thoroughly historicist outlook that is present in all forms of pragmatism, even if not as well thematized as it might have been. On his reading, then, “pragmatism’s most important philosophical contribution is that of redescribing the philosophical practices (...) of thought, critique, and inquiry such that these practices take place in time and through history.”1 Adopting such an historicist outlook on the development of pragmatism .. (shrink)
An account of the specific ill of Native American mascots—that is, the particular racism of using Native Americans as mascots, as distinct from other racist portrayals of Native Americans—requires a fuller account of the function of mascots as such than has previously been offered. By analyzing the history of mascots in the United States, this article argues that mascots function as symbols that draw into an artificial unity 1) a variety of teams existing over a period of time and thereby (...) 2) a community of individuals who are thus able to use that team as their own symbolic locus of unification. This unification of teams and their concomitant communities is accomplished by appeal to a symbol that facilitates a particular fantasy of collective identity. The usage of Native American mascots is racist not only because it involves stereotypical portrayals of Native Americans, but because it treats Native persons simply as a means to symbolic unification—and not, importantly, as members of the community they thus serve. In other words, in these cases mascots work as unifying signifiers precisely by being the purely instrumental facilitator of a group's collective fantasy of itself. (shrink)
To many Western students of India, svarāj and mokṣa have often seemed to represent two very different ideals of freedom, the former social, political, and modern; the latter individual, spiritual, and traditional. It is not surprising that the Hindu ideal of spiritual freedom is most commonly known by the term mokṣa , for it is this word that is usually listed as the fourth and supreme goal in the famous four ends of man . The first three ends, desire , (...) success , and morality , find their fulfillment within society, while mokṣa , it is generally said, takes one beyond society. It is pertinent to note, as Ingalls and others have pointed out, that mokṣa is a relatively late term, which came to be added to the older, first three goals of man. As a noun, mokṣa does not appear until the latest of the Upanisads, and then only three times, in Śvetāśvatara 6.16 and Maitrī 6.20 and 30. In addition, some orthodox schools did not accept the ideal of mokṣa for several more centuries, the Mīmāṁsā denying it until the eighth century A.D. (shrink)