Taking Liberties (and Libertarians) Seriously

By Abby Moncrieff

First, an uncontroversial statement: Despite academics’ resistance, libertarian arguments played a huge role in the Supreme Court’s Obamacare decision. That seems obvious. Chief Justice Roberts and the four dissenters based their Commerce Clause analyses largely on notions of individual freedom, asserting that the federal government should not be allowed to force individuals to purchase private products.

But to heath scholars, that line of analysis is incredibly irksome and even a bit dissonant. Health insurance isn’t like ordinary private products, we cry; it is intimately connected to health care regulation, and forcing people to have health insurance, unlike forcing them to buy (or even eat) broccoli, will make them healthier! Congress made this point explicitly, finding that “[t]he economy loses up to $207[ billion] a year because of the poorer health and shorter lifespan of the uninsured”! Failing to eat broccoli doesn’t make you unhealthy the same way that failing to carry insurance does, especially if you’re substituting broccoli with green beans instead of donuts. And eating broccoli doesn’t make you healthy the same way that carrying insurance does, especially if you’re also eating steaks (or eating more than 2000 calories a day of pure broccoli). So, Supreme Court, you just got it wrong. The individual mandate isn’t a crass attempt to get people to buy something. It is, like countless other uncontroversial provisions of the U.S. Code, an attempt to improve the health and longevity of the American people. If you don’t think Medicare (or a Certificate of Need law) infringes liberty, you shouldn’t think the individual mandate does.

Here’s the problem: The Solicitor General didn’t make that argument.

Read More

“The New Normal” and Reproductive Technology and the Law

Inspired in part by attending the “Baby Markets Roundtable” (an annual gathering of reproductive technology and the law scholars) this week at Indiana Bloomington, I wanted to share a few thoughts on the new NBC television show The New Normal. The series is a sitcom that follows the lives of a gay male couple (David and Bryan) who decide to employ a surrogate (Goldie), who herself has a young child through a prior relationship (Shania). The last cast member that is part of the family is the Goldie’s fairly right-wing grandmother known as “Nana.”

First the good: This is one of the few portrayals of surrogacy on TV, period. With a few exceptions, usually surrogacy comes in as a plot-of-the-week on lawyer shows when something has gone wrong. Here is one of the few positive, normalizing, portrayals of surrogacy.

Now the not-so-good:

Read More

Petrie-Flom Interns’ Weekly Round-up: September 16-28

[Ed. Note: We have a few weekly round-ups available here at Bill of Health (from Yale’s Interdisciplinary Center for Bioethics, and from Nic Terry‘s list of what’s worth reading each week), but we’ll give you one more from our Petrie-Flom interns for good measure.  And this week – a bonus!  A two-week round-up…]

By Hyeongsu Park and Kathy Wang

  • On Thursday, September 20, the Appellate Court of Illinois ruled that pharmacists can refuse to dispense emergency contraceptives because of religious beliefs. The court’s opinion can be found here. (And Nadia Sawicki’s post here.)
  • An article published on guardian.co.uk introduces Ben Goldacre’s book Bad Pharma: How drug companies mislead doctors and harm patients. The book describes how drug manufacturers do not disclose full information about the drugs they produce to doctors and patients, resulting in potential harms to patients.
  • The Inter-American Court of Human Rights will decide within the next few months whether Costa Rica, the only country that forbids in vitro fertilization, has infringed basic rights with its ban.
  • Two Swedish women have donated their wombs to their daughters hoping that the daughters will be able to bear children. These are the world’s first mother-to-daughter uterus transplants.
  • A BioEdge blog introduces Tom Koch’s book Thieves of Virtue: When Bioethics Stole Medicine. The book unsparingly attacks the entire discipline of bioethics and questions its raison d’etre.
  • A recent Congress-mandated report by the National Research Council voiced concerns over the implications of a growing, aging population on the economy and federal policy. The Council and corresponding experts expressed their doubts over the sustainability of programs such as Medicare, Social Security, and Medicaid and urged for policy makers to find alternatives to these programs.

Read More

Obama v. Romney on Health Care

Ok, so we’ll have a NEJM-heavy day today! But you’ve got to check out one more thing, statements from the presidential candidates on the future of American health care.  This was the topic of a hugely successful Petrie-Flom Center event earlier this week, which was – sadly – off the record.  We heard from the candidates’ representatives, but here it is directly from the source(s):

NEJM: Cutting Family Planning in Texas (and more)

Our friends over at the New England Journal of Medicine just alerted us to a new perspectives piece addressing the impact of cutting family planning funds in Texas (the piece was also picked up by Politico).  The authors interviewed 56 leaders of organizations throughout the state that provided reproductive health services using public funding before cuts went into effect, and what they found was disturbing:

  • Most clinics have restricted access to the most effective contraceptive methods because of their higher up-front costs (choosing pills over IUDs or subdermal implants).
  • Clinics have started to turn away those who canot pay, when previously their visits would have been covered by public funds, and women who can pay the newly instated fees are choosing less effective methods and fewer tests to save money.
  • A number of clinics have lost their exemption from Texas’ law requiring parental consent for teens under 18 who seek contraceptives.

Overall, the authors conclude that laws intended to defund Planned Parenthood in an attempt to limit access to abortion (even though federal and state funding cannot be used for abortion anyway) have resulted in policies limiting women’s access to range of preventative reproductive health services and screenings.

Alta Charo weighs in via a NEJM podcast, discussing the future of reproductive health care for women in the US, particularly in light of upcoming elections (as well as the article we discussed last week on conscientious action, and other general issues in reproductive health policy).  Take a listen!

And one more NEJM plug for now: our Bill of Health blogger Kevin Outterson also has a podcast online discussing the record-breaking settlements of pharmaceutical fraud cases and the need for further regulation.

Needing a Lawyer on the Team

by Wendy Parmet

It’s easy to see the value of including scientists in public health law research teams; most public health lawyers lack the training to conduct rigorous empirical research.  It may be harder to see the need for adding lawyers to the research team, but their presence is no less critical. Sometimes scientists have as much trouble understanding the law as the lawyers have understanding the science.

The value of involving lawyers in public health law research became clear to me recently as I was working on a project relating to health policies affecting immigrants. One question I wanted to know was how the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) affected immigrants’ access to health insurance in the United States.  So I decided to review the scientific literature. The results were dismaying.

Read More

Some Thoughts on Sandel’s “What Money Can’t Buy”

By Cansu Canca

Last Wednesday, I went to Michael Sandel’s lecture introducing his new book What Money Can’t Buy: The Moral Limits of Markets. His talk focused on two main arguments: There should be certain norms that govern our relationship with certain goods; and markets corrupt these norms.

I think Sandel’s position fails in three respects:

  1. The book does not provide a theoretical basis for these norms. In other words, the book does not explain where these norms come from, which norms are suitable for which relationships, or how they are violated.
  2. Given the lack of theoretical basis, the book cannot identify a stopping point for its suggestion to preserve and cultivate virtues related to these norms. There would seem to be many more activities to which the book’s suggestions could be expanded, yet even Sandel does not seem willing to go there. To the extent one accepts it, Sandel’s argument thus proves too much.
  3. Instead of presenting a theoretical basis, the book proceeds by analogy. But the analogies seem unconvincing in that their source and target situations seem materially different.

Let me flesh out these points.

Read More

Upcoming Event at the JFK Jr. Forum: Health Care in 2013: Why the Race for the Presidency Matters

This Monday, October 1, 2012 @ 6PM, our friends at the John F. Kennedy Jr. Forum at the Harvard Kennedy School are hosting a panel on Health Care in 2013: Why the Race for the Presidency Matters. The event will feature:

  • Robert Blendon, Menschel Professor; Senior Associate Dean, Harvard School of Public Health
  • Vivek Murthy, President, Doctors for America
  • Thomas Scully, Administrator, Centers for Medicare and Medicaid Services (2001-2003)
  • Sheila Burke, Adjunct Lecturer in Public Policy; Faculty Research Fellow, Malcolm Wiener Center for Social Policy (moderator)

Location: John F. Kennedy Jr. Forum at the John F. Kennedy School/Harvard
79 JFK Street
Cambridge, MA
(corner of JFK and Eliot Streets)

Can’t make it? Watch the event live.