Tag: insurance

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Millions More Uninsured Could Impact Health Of Those With Insurance, Too

Much has been written lately about how individuals’ health could suffer if they lose insurance under the health proposals circulating in the U.S. House and Senate. But there is another consequence: creating millions more people without insurance could also impact the health of people who remain insured

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Diagnostic dilemmas: When potentially transient preexisting diagnoses confer chronic harm

By Elaine Walker
Elaine Walker is the Charles Howard Candler Professor of Psychology and Neuroscience at Emory University.   She leads a research laboratory that is funded by the National Institute of Mental Health (NIMH) to study risk factors for psychosis and other serious mental illnesses.  Her research is focused on the behavioral and neuromaturational changes that precede psychotic disorders.   She has published over 300 scientific articles and 6 books. 
The diagnostic process can be complicated by many factors. Most of these factors reflect limitations in our scientific understanding of the nature and course of disorders. But in the current US healthcare climate, legislative proposals concerning insurance coverage for preexisting conditions add another layer of complexity to the diagnostic process. It is a layer of complexity that is riddled with ethical dilemmas which are especially salient in the field of mental health care. The following discussion addresses the interplay between medical practice and health-care system policy in the diagnostic process. The diagnosis of psychiatric disorders is emphasized because they present unique challenges [1]. 

Of course, some of the complications associated with diagnosis are a function of ambiguous and/or changing diagnostic criteria. For example, the criteria for designating the level of symptom severity that crosses the boundary into clinical disorder change over time as a function of scientific advances. This has occurred for numerous illnesses, including metabolic, cardiovascular, and psychiatric disorders [2]. Further, especially in psychiatry, diagnostic categories undergo revision over time, even to the extent that some behavioral “syndromes” previously considered an illness have been eliminated from diagnostic taxonomies.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Preeclampsia: Study Highlights Need for More Effective Treatment, Prevention

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It’s well known that preeclampsia, a condition characterized by a progressive rise in a pregnant woman’s blood pressure and appearance of protein in the urine, can have negative, even life-threatening impacts on the health of both mother and baby. Now, NIH-funded researchers have documented that preeclampsia is also taking a very high toll on our nation’s economic well-being. In fact, their calculations show that, in 2012 alone, preeclampsia-related care cost the U.S. health care system more than $2 billion.

These findings are especially noteworthy because preeclampsia rates in the United States have been steadily rising over the past 30 years, fueled in part by increases in average maternal age and weight. This highlights the urgent need for more research to develop new and more effective strategies to protect the health of all mothers and their babies.

The causes of preeclampsia remain somewhat mysterious, though recent data suggest a role for proteins produced by the placenta. Because preeclampsia affects a pregnant woman’s vascular system, her unborn child can be deprived of needed oxygen and nutrients. In mild cases, the condition can often be managed with careful monitoring and blood pressure medications. But if the symptoms become severe and potentially life-threatening to either mother or child, the only answer is to induce early delivery, which carries its own health risks and high health care costs.

In the study reported in the American Journal of Obstetrics & Gynecology, a team led by Anupam Jena at Harvard Medical School, Boston, set out for the first time to quantify those costs up to a year after delivery.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Deaths from a Health Care Bill?

July 10, 2017

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House Minority Leader Nancy Pelosi has said “hundreds of thousands of people will die” if the Senate health care bill becomes law. But what does the research say about the impact of health insurance on mortality rates?

There are several studies backing up the idea that those who lack health insurance have a higher chance of dying prematurely than those with insurance, as we found when we looked at this issue in 2009.

But the research uses terms like “could” and “suggests” and “cannot definitively demonstrate a causal relationship,” not the definitive “will” favored by opponents of the bill. We can’t say whether any specific projection is a correct or valid number.

Democrats have made this a talking point. “We do know that many more people, hundreds of thousands of people, will die if this bill passes,” Pelosi said on “CBS This Morning” on June 26. In a July 2 interview on CNN’s “State of the Union,” Sen. Bernie Sanders said “tens of thousands of people every single year will die” if the Affordable Care Act were repealed entirely, without a replacement.

Later in that interview, Sanders said that “no one knows exactly the number” but that one study said “up to 28,000 people a year … will die” from the increase in the uninsured under the Republican bills. He and Pelosi are referring to an analysis by the left-leaning Center for American Progress.

We’ll explain how that study reached its conclusions, as well as what other research has found.

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The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Never Let an Ill Child Go to Waste

The Charlie Gard saga is one about which I’ve been reluctant to say anything, not least because plenty of other people have said plenty elsewhere.  Sometimes they add heat, and sometimes they add light.

Beneath everything, the story is fairly simple: a small child is terribly ill; it is agreed by medical opinion that continued treatment is not only not in his best interests but would cause him positive harm; the courts have determined that the withdrawal of treatment is warranted.  One sympathises with his parents’ fight to keep treatment going – but it does not follow from that that their opinions should be determinative.  Indeed, the courts having decided that Charlie’s treatment should not be withdrawn immediately in order to allow his parents more time with him risks making the case about them, rather than about him.  If treatment is not medically warranted and actually is harmful, there may be something worrisome about continuing it anyway for the sake of his parents.  Their distress is not going to lessened by prolonging the child’s treatment, and even if it were, it is not the proper focus here.

So that’s my hot take on the story itself.  I don’t think it’s anything too radical.  Yet the coverage of the case has been, in places, something of a trainwreck.  Take, for example, this piece from the Chicago Tribune (with thanks to Charles Erin for the pointer).  It’s fascinating for just how much it manages to get wrong, and how mawkish it is, and for what it does with the story to such unpleasant ends.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Healthcare Insurance vs. Healthcare coverage?

Kimberly Strassel wrote an interesting piece in the WSJ entitled “The Simplicity of a Health Deal” (Link here – subscription required). I don’t think she was saying that crafting legislation to resolve all of America’a healthcare issues was easy, she was making the political point to Senate Republicans that, like it or not, no future legislation will be possible unless they agree to continue the… // Read More »

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Do Americans suddenly like Obamacare?  Contextualizing opinion polls and media narratives by Jessica Mulligan

“Repeal and replace” has been the rallying cry for opponents of the Affordable Care Act (ACA or Obamacare), the signature domestic policy of the Obama administration that expanded insurance coverage to 20 million people. Opposition to the ACA inspired populist social movements and helped elect Republicans to state and national office. Donald Trump tweeted hundreds of times that Obamacare was a “disaster” and promised to repeal and replace the health law. And yet, since he took office in 2017, public opinion polling shows that more Americans hold favorable views than unfavorable views of the law, reversing previous trends. Constituents have confronted members of Congress at rowdy town hall meetings and demanded that their health coverage be protected. Bewildered Republicans and health policy wonks are scratching their heads, trying to make sense of the sudden surge in support for what has been an unpopular law. Finally ready to make good on their campaign promises to repeal and replace, Republicans are met by desperate Americans, many with preexisting conditions, who fear their coverage will soon disappear.

Here, we explore this pendulum shift in public opinion poll results about the popularity of the ACA. We argue that, in fact, many pollsters and policy wonks never really understood the complicated assessments that people held of the ACA in the first place. A question about favorable or unfavorable views fails to capture the stakes of the ACA for those with and without health insurance. Poll data show that major reasons for disliking the health reform included increased costs, that it created too big a role for government, that it took the country in the “wrong direction” under President Obama, and that it did not go far enough in expanding coverage.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Identity politics, partisanship and healthcare by Maria Cecilia Dedios

The problem of intense polarization in politics -and in society more generally- has been on the spotlight for several months now. In the past couple of weeks, we’ve been bombarded by headlines, arguments, and op-eds that show the extent to which this polarization is impacting something that should not –at least in principle- be a matter of partisanship: The provision of healthcare for the American people. How did we get here? This month the web round-up focuses on some attempts at answering this question in various online outlets.

 

To begin with, there seems to be very different understandings of health along party lines, either as a right or as a commodity. One side understands health care similar to a right, arguing for equity in access to health care based on the idea of a societal obligation towards those who can’t afford access to health care, arguing that health care access represents a way to provide equal opportunities to everyone. The other side sees health care as a commodity, something that each person can freely decide whether to acquire or not. Also, this argument goes, the government should and could not pick up the bill when it comes to cover health care for all. That, the right argues, would be a government overstep with no constitutional basis.

 

Things are further complicated by identity politics, which is one of the most complex issues to deal with in relation to political polarization. Because the discussion becomes about who you are, and things are framed in an “us vs.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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In the Journals – June 2017, part two by Aaron Seaman

The first part of the In the Journals post for June 2017 can be found here. And now, for part two…

 

Medical Humanities

SPECIAL ISSUE: Communicating Mental Health

Introduction: historical contexts to communicating mental health

Rebecca Wynter and Leonard Smith

Contemporary discussions around language, stigma and care in mental health, the messages these elements transmit, and the means through which they have been conveyed, have a long and deep lineage. Recognition and exploration of this lineage can inform how we communicate about mental health going forward, as reflected by the 9 papers which make up this special issue. Our introduction provides some framework for the history of communicating mental health over the past 300 years. We will show that there have been diverse ways and means of describing, disseminating and discussing mental health, in relation both to therapeutic practices and between practitioners, patients and the public. Communicating about mental health, we argue, has been informed by the desire for positive change, as much as by developments in reporting, legislation and technology. However, while the modes of communication have developed, the issues involved remain essentially the same. Most practitioners have sought to understand and to innovate, though not always with positive results. Some lost sight of patients as people; patients have felt and have been ignored or silenced by doctors and carers. Money has always talked, for without adequate investment services and care have suffered, contributing to the stigma surrounding mental illness. While it is certainly ‘time to talk’ to improve experiences, it is also time to change the language that underpins cultural attitudes towards mental illness, time to listen to people with mental health issues and, crucially, time to hear.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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The Limits of Choice: Abortion and Assisted Dying

Michelle Oberman compares abortion and assisted dying and argues that focusing on the ‘right to choose’ risks ignoring the social and economic factors that shape and constrain our choices.

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I’ve watched the trend toward legalizing physician assistance in dying with a vague sense of alarm. My peers, healthy and wealthy, are puzzled by my response. How is this different from abortion, they ask? You’re pro-choice on abortion, so why wouldn’t you be for assisted dying?

Here’s my problem: As much as I support reproductive rights, I am weary of the rhetoric of ‘choice’ as it applies to great swaths of women who have abortions. I’ve spent the past six years studying abortion in the United States, and in countries like El Salvador where abortion is completely banned. The more I’ve learned about why many women have abortions, the less I see abortion as a choice. Abortion is often a coerced response to desperate circumstances.

When we focus on the question of choice – framing the issue as one of individual liberty – we ignore entirely the social and economic factors that shape and constrain choice. Such constraints lead many women to undergo abortions they might otherwise deeply prefer to avoid. The most common reason that women give for seeking an abortion is financial. It is expensive to have a baby, to pay for day care, to feed, clothe, and house a child. For marginally-employed women, having a baby necessarily means plunging themselves and their families deeper into poverty.

We’ve spent decades fighting over abortion, yet we have done little to offset the economic pressures that compel some women to have one.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.