CHICAGO, ILLINOIS, USA - JUNE 8, 2019: First ever Medicare for All rally led by Bernie Sanders held in The Loop of Chicago. Crowd holds up a sign that says "Medicare for All Saves Lives".

Sustaining the Promise of Universal Access

By David Orentlicher

Should the United States achieve universal access to health care by adopting a single-payer, Medicare-for-All kind of system? Or should we build on the Affordable Care Act (ACA) and not disrupt the health care coverage of the 160 million Americans who have private health insurance?

Both reforms rely on important arguments about affordability, feasibility, and consumer choice. But there is one key reason to favor a single-payer system over an expansion of our current system. Experience with public benefit programs in the United States tells us that such programs thrive only when they serve all Americans.

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Hand placing wood toy block on top of a tower. The blocks all have images of medical-related items on them, like pills, stethoscope, syringe

Lost in the Jungle of Patient Safety Reports, Publications and Initiatives?

By John Tingle

In terms of the progress of developing a patient safety culture in the National Health Service (NHS) in England, the Daily Telegraph reports comments made by Professor Ted Baker, the Chief Inspector of Hospitals at the Care Quality Commission (CQC) at a recent conference in London. He held the view that “little progress” has been made improving patient safety in the NHS in 20 years, and that never events such as wrong site surgery were still happening because the overall culture is one of defensiveness. The Telegraph reported, “He told The Patient Safety Learning conference that hospital managers routinely hide evidence from the CQC, because they regard the organisation as out to blame them.”

The Telegraph also mentions an NHS estimate in July that 11,000 patients a year may be dying as a result of blunders, partly as a result of a “blame game” culture between staff.

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Blurred image of a patient in critical condition in the ICU ward.

“An Act Improving Medical Decision Making:” An Argument in Favor of MA House Bill 3388 and Senate Bill 843

By Beatrice Brown

On September 10, 2019, the Joint Committee on Judiciary at the Massachusetts State House heard testimony regarding House Bill 3388 and Senate Bill 843, “An Act Improving Medical Decision Making.” The Massachusetts Medical Society (MMS) was among those testifying in favor of the act. As noted by MMS, Massachusetts is one of only five states in the U.S. that does not have a default surrogate consent statute for incapacitated patients without a health care proxy. The intent of a default surrogate consent statute is “to provide legal authority for health care decision-making through a non-judicial rule of law where no guardian or agent had been appointed.”

Without such a statute in place, this means that a patient who is incapacitated and has not declared a health care proxy must await treatment while a guardian is appointed by the courts. This may be a lengthy, time-consuming process that physically drains hospitals’ resources and emotionally drains families. By contrast, these default surrogate consent statutes establish a list of surrogates that can be appointed by physicians to make decisions in lieu of the incapacitated patient. For example, in the Massachusetts bills, the following persons are listed as candidates who may be appointed as surrogates: the person’s spouse, unless legally separated; the person’s adult child; the person’s parent; the person’s adult sibling; and any other adult who satisfies the requirement of subdivision seven of the bill which states, “The person’s surrogate shall be an adult who has exhibited special care and concern for the person, who is familiar with the person’s personal values, who is reasonably available, and who is willing to serve.” Read More

Photograph of a doctor in scrubs holding a stethoscope sitting on a hospital bed holding a patient's hand.

World Patient Safety Day

By John Tingle

The first “World Patient Safety Day” took place on September 17, 2019. It is an annual event and one of  the World Health Organization’s (WHO) officially mandated global public health days. The aim is to create awareness of patient safety and to urge people to show their commitment to making health care safer. The publicity generated by the event has worked to focus global attention on patient safety issues and is a call for action in the area.

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Nudges or Shoves in the Secondary Use of Health Data: What is the More Desirable Approach? (Part I)

By Marcelo Corrales Compagnucci, Janos Meszaros & Timo Minssen

Empirical studies in behavioral economics have demonstrated how people are biased and often make poor decisions against their best interests. This has led policy makers to promote choice-preserving approaches, a.k.a. nudges. However, there has also been an increasingly vocal group of legal scholars who are interest in asking whether mandates and bans can be more effective than nudges. As pointed out by Cass R. Sunstein and others, the rationale behind this question is very simple: If we know that people make mistakes, why should we insist on adopting approaches that preserve freedom of choice?

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New TWIHL; Too Much Information About State Health Insurance Law

By Nicolas Terry

This episode was recorded at the 2019 meeting of the Southeastern Association of Law Schools during a panel reviewing the year in healthcare financing. In this episode I take a look at state regulation of health insurance, first, from the perspective of states playing defense and shoring up their own laws in case the ACA is “disappeared” and, second, how some are playing post-ACA offense, actually seeking to improve upon the ACA baseline. The slides accompanying this talk are here.

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Promoting Health, Not Just Health Care

By David Orentlicher

Once again this past Thursday, the Democratic presidential candidate debate began on the topic of health care reform, and moderator George Stephanopoulos quickly steered the discussion to what he termed “the heart” of the debate. Should the United States increase access to care by building on the Affordable Care Act (ACA) or by replacing ACA with a single-payer, Medicare-for-All system?

While this is an important question, there is an even more important question for the candidates to discuss. We need to hear them talk more about health than about health care.

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The Care Quality Commission (CQC) in England: Annual Review of Progress

By John Tingle

The Care Quality Commission (CQC) occupies a pivotal role in the National Health Service (NHS) and social care sector in securing health quality and patient safety. Its inspection activities through its reports and publications form the backbone of quality and safety in these sectors. As the independent regulator of health and social care in England it faces a mammoth task. The CQC has recently published its annual report and accounts, which provide useful insights into its work. The report provides a window on how England regulates health, social care quality, and patient safety. There is detailed reflection in the report about how the organisation can better perform its functions and the challenges and opportunities currently facing it.

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Trends in NHS Clinical Negligence Litigation Revealed in Latest NHS Resolution Annual Report and Accounts

By John Tingle

NHS Resolution is a major National Health Service (NHS) organisation concerned with patient safety, health quality, and litigation management in the NHS and provides essential infrastructure services. NHS Resolution has recently published its 2018/19 annual report and accounts, which contains valuable insights into the current state of clinical negligence litigation in the NHS in England. Several key themes and trends are identified in the report.

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What You Need to Know About “Medicare and Medicaid-for-all” to Survive the Current Election Cycle

By Jennifer S. Bard

Just as medical students find themselves being asked at parties to look at rashes, this year health law students (and professors) are being asked about the proposals to fix our broken health care system being offered by the many candidates vying for the Democratic Party’s nomination for president. Talk about these issues are certain to continue through the primaries as 81% of Democrats agree that “the federal government has a responsibility to make sure all Americans have health coverage.” While Republicans are less sure about who should pay, health care remains a top issue for 69% of the electorate.

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