African governments spend millions of dollars every year training physicians who will leave their home countries to live and work in wealthier nations. The result is that for countries like Ethiopia, Kenya, and Sierra Leone, more of their native physicians are now in the United States and Europe than at home. This massive movement of physician has likely contributed to health crises in many African nations, where citizens die of easily curable diseases each year.
Category: Student Fellows
Prosecuting Healthcare Fraud: The Need for Statutory Guidance on Costs and Benefits
The Trump Administration launched the largest healthcare fraud takedown in history in June, charging over 600 individuals responsible for over $2 billion in fraud losses. This takedown, along with the previous summer’s (which had previously been the largest when it happened) has allayed concerns that the Justice Department would ease off healthcare fraud prosecutions as a form of white-collar, rather than violent, crime.
Indeed, former Attorney General Sessions committed to aggressive prosecution of healthcare fraud as part of the Administration’s response to the opioid epidemic. One change does seem clear, however: the Administration is prioritizing the prosecution of individuals, and scaling back on the prosecution of corporations. Read More
Drug Pricing Controls and the Power of Familiar Ideas
Eight in ten Americans think that prescription drug prices are unreasonable, according to a March 2018 Kaiser poll. That same poll found that more Americans considered passing legislation to lower drug pricing to be a top priority than passing legislation to improve infrastructure or to address the prescription painkiller epidemic, among other things.
Effectively addressing drug pricing is a complex task that will require the diligent efforts of many actors. On October 24, the Petrie-Flom Center held a full day’s programming to this important and timely topic. What I want to state here is a simple point—namely, that the very discussion of potential solutions can play a role in turning creative innovations into implementable solutions.
The leaked HHS memorandum and transgender health rights
At the end of last month, the New York Times reported on a leaked internal memorandum from Health and Human Services proposing to narrowly define “sex” as “biological sex,” a move made with the purpose of excluding transgender people from a variety of civil rights protections.
The memorandum stirred concerns about the future of Section 1557 of the Affordable Care Act, which provides for an anti-discrimination cause of action in health care settings and has been the basis of a number of private lawsuits by transgender patients. The HHS memorandum reinforces that the Trump administration plans to reinterpret Section 1557 to stem this litigation.
Congress’s opioids package and the politics of the IMD exclusion
At the end of September, the Senate passed a final version of an expansive legislative package designed to tackle the United States opioid epidemic. The package contains a broad range of policy approaches to the crisis, including enhanced tracking of fentanyl in the U.S. mail system, improved access to Medication Assisted Treatment and addiction specialists, and lifted restrictions on telemedicine and inpatient addiction treatment. The package, which now sits on President Trump’s desk, is widely expected to be signed into law.
The legislative effort has been lauded as a rare act of bipartisanship in an otherwise-polarized Washington.
The Washington Post called the set of bills “one of the only major pieces of legislation Congress is expected to pass this year.” A Time headline declared that “Opioid Bill Shows Congress Can Still Work Together.” Praise of this across-the-aisle effort is merited: the Senate voted for the set of bills 98-1, and the House voted for it 393-8.
While critics have rightfully pointed out that the package does not provide for enough increased spending to address the crisis, with more than 72,000 people dying from drug overdoses in 2017, the time is ripe for a collaborative approach to the opioid crisis, and any effort helps.
The Millennial Need for Speed in Healthcare
According to a recent Kaiser Family Foundation (KFF) poll, shockingly large swaths of Americans have reported that they don’t have a primary care provider.
The July 2018 report found that 45 percent of 18-29 year olds, as well as 28 and 18 percent of 30-49 and 50-64 year olds, respectively, also lack designated primary care.
Kaiser Health News (KHN) explained that the price transparency, convenience, and speed of alternatives to office-based primary care physician (PCP) visits appear to be some of the preferences driving these patterns. Retail clinics, urgent care centers, and telemedicine websites satisfy many of these preferences, and are therefore appealing alternatives to scheduled appointments with a PCP. For example, extended hours and shorter wait times at increasingly widespread retail clinics have attracted young patients who want to avoid the hassle and wait times involved in scheduling and attending a traditional doctors office.
A 2015 PNC Healthcare survey similarly found that millennials saw their PCP significantly less (61 percent) than baby boomers and seniors (80 and 85 percent, respectively). The study emphasized the effects of technology on millennials’ trends in healthcare acquisition, such as higher utilization of online reviews to shop for doctors (such as Yelp). It also found that millennials are much more likely to prefer retail and acute care clinics, and are more likely to postpone treatment due to high costs than older generations.
Southern Indiana’s HIV Outbreak: A Lesson on the Importance of Incentivizing HIV Testing
By 2015, major news outlets were reporting on what the CDC was calling “one of the worst documented outbreaks of HIV among IV users in the past two decades.” Between 2011 and 2015 over 200 people in southern Indiana’s Scott County acquired HIV. The primary source of the spread was the sharing of needles to inject opioid drugs. While the outbreak has now been contained, there linger many lessons to be learned from the tragedy that struck this small rural county in southeast Indiana.
Some of those lessons are about the havoc being wreaked on much of rural America by opioid abuse. But the lessons I’m focusing on here are the dangers of disincentivizing HIV testing, especially among high-risk populations like injection drug users. Read More
The Drinking Age and Law Enforcement on College Campuses
When I was a senior in college, after having worked for the Cornell University Police Department for four years, I hosted a town hall meeting to promote and improve the Blue Light Escort Service, a service which most colleges have to give students safe, free late-night walks home by law enforcement or affiliated personnel.
One of the key takeaways of the meeting, as I knew it would be, was that many students were unsure of the relationship of the escort service to enforcement of underage drinking laws: they were scared that if they were drunk underage and called for an escort, they would get in trouble.
This post is, in a sense, about a narrow issue: the effect of the national minimum legal drinking age (MLDA) of 21 on campus law enforcement. More broadly, however, it’s about a specific and often overlooked result of a legal framework that ostensibly-but-not-really makes criminals of the hundreds of thousands of college students who live on their own and are legally considered to be adults, for behavior that virtually all other adults engage in with laws that are virtually but not entirely unenforced.
It’s kind of a weird thing, if you think about it.
Mary Mayhew: The New Anti-Medicaid Head of Medicaid
Mary Mayhew, a fierce opponent of Medicaid Expansion under the Affordable Care Act, was announced on October 15 as the new Deputy Administrator and Director of the U.S. Center for Medicaid and CHIP [Children’s Health Insurance Program] Services. As the House Ways and Means Committee Democrats put it in a recent tweet, the Trump Administration’s choice “is like hiring an arsonist to be a city’s fire chief.”
Mayhew spent years as commissioner of Maine’s Department of Health and Human Services under outgoing Governor Paul LePage. She stepped down in May 2017. After her time as commissioner, Mayhew pursued an unsuccessful race for Governor of Maine, coming in third in the Republican Primary this past June.
The Maine Department of Health and Human Services’ approach to Medicaid under Mayhew’s leadership does not exactly suggest she will take an expansive approach to Medicaid in her new role. According to the ACLU of Maine, enrollment in MaineCare, Maine’s Medicaid program, decreased by 37 percent during her time in office, eliminating coverage for about 80,000 people.
The state also dropped from 10th to 22nd in national health rankings.
What are the Ethics of Electronic Consent Forms?
While bioethics has generally understood technologies to be a source of ethical problems, there is relatively little reflection about issues associated with technology’s role in bioethics itself. The move towards electronic consent is one area in technology. While there is substantial research on consent and the consent process the gradual shift towards digital consent forms appears to have arrived without necessary bioethical reflection. What are the ethical implications of this shift?
Yet, there are other more compelling questions that this brings about: Could the digitization of consent forms support even more robust kinds of consent on the part of patients and research subjects? Given what we know about the gaps between the ideals of consent and the reality of consent in clinical and research settings, could electronic supports be used precisely in areas where consent “breaks down?” How might ethical aims be sustained or emboldened via systems?
