June 25th, 2012
atomvincent

Health Care and the High Court

As the nation awaits the forthcoming Supreme Court verdict on the healthcare mandate, let’s take a moment to look at what, exactly, has been deliberated, and what’s at stake. From May of this year, Ronald Dworkin writes on the importance and constitutionality of the healthcare law for the New York Review of Books.

The plaintiffs have asked the Court to declare the Affordable Care Act unconstitutional. The political and social stakes are enormous. But the legal issues, most analysts think, are not really controversial: the Constitution’s text, the Supreme Court’s own precedents, and basic constitutional principle seem obviously to require upholding the act. Analysts at first predicted a 7–2 decision rejecting the challenge. But they apparently misjudged the dedication of the ultraconservative justices, whose questions in the oral argument have now convinced many commentators that on the contrary, in spite of text, precedent, and principle, the Court will declare the act unconstitutional in June, by a 5–4 vote. That prediction may be too swift. There is still reason to hope, as I discuss later, that Justice Anthony Kennedy, often the swing vote between liberals and ultraconservatives, will have sufficient respect for congressional authority to save the act.

The prospect of an overruling is frightening. American health care is an unjust and expensive shambles; only a comprehensive national program can even begin to repair it. One in six Americans lacks any health insurance, and the uninsured of working age have a 40 percent higher risk of death than those who are privately insured. Insurance is often unavailable even for those willing and able to pay for it: according to the Government Accountability Office, an average of 19 percent of individual applications for insurance are declined for a variety of reasons including the applicant’s being on a prescription medicine or being overweight.

If the Court does declare the act unconstitutional, it would have ruled that Congress lacks the power to adopt what it thought the most effective, efficient, fair, and politically workable remedy—not because that national remedy would violate anyone’s rights, or limit anyone’s liberty in ways a state government could not, or be otherwise unfair, but for the sole reason that in the Court’s opinion our constitution is a strict and arbitrary document that denies our national legislature the power to enact the only politically possible national program. If that opinion were right, we would have to accept that our eighteenth- century constitution is not the enduring marvel of statesmanship we suppose but an anachronistic, crippling burden we cannot escape, a straitjacket that makes it impossible for us to achieve a just national society.

Read the full article here.

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April 12th, 2012
arvindsuguness
The Best Health Care In The World?
Opponents of health care reform often argue that despite its high costs, our system provides the highest quality of care in the world and that any changes would therefore be counterproductive. While reviewing a new study for Reuters, Sharon Begley explains why the favorite statistic of reform opponents, cancer survival, is a flawed metric for judging the quality of our health care system:

If a tumor is diagnosed very early in its existence - if it has a long “lead time” - the patient may survive, say, two years if the tumor is very aggressive. If an identical tumor is found in that patient’s identical twin later, the twin will survive, say, six months. But the twins die at the same age. The first survived longer with cancer due to lead-time bias, but did not have a longer lifetime.
…
Even more problematic, said Berry, is a problem cancer experts have only recently recognized: overdiagnosis. Because cancer screening is much more widespread in the United States than in Europe, especially for breast and prostate cancer, “we find many more cancers than are found in Europe,” he said. “These are cancers that tend to be slowly growing and many would never kill anyone.”
Screening therefore turns thousands of healthy people into cancer patients, even though their tumor would never threaten their health or life. Counting these cases, of which there are more in the United States than Europe, artificially inflates survival time, experts said.

Read the full article here.
// Follow Read This, Not That on Tumblr / Facebook / Twitter //

The Best Health Care In The World?

Opponents of health care reform often argue that despite its high costs, our system provides the highest quality of care in the world and that any changes would therefore be counterproductive. While reviewing a new study for Reuters, Sharon Begley explains why the favorite statistic of reform opponents, cancer survival, is a flawed metric for judging the quality of our health care system:

If a tumor is diagnosed very early in its existence - if it has a long “lead time” - the patient may survive, say, two years if the tumor is very aggressive. If an identical tumor is found in that patient’s identical twin later, the twin will survive, say, six months. But the twins die at the same age. The first survived longer with cancer due to lead-time bias, but did not have a longer lifetime.

Even more problematic, said Berry, is a problem cancer experts have only recently recognized: overdiagnosis. Because cancer screening is much more widespread in the United States than in Europe, especially for breast and prostate cancer, “we find many more cancers than are found in Europe,” he said. “These are cancers that tend to be slowly growing and many would never kill anyone.”

Screening therefore turns thousands of healthy people into cancer patients, even though their tumor would never threaten their health or life. Counting these cases, of which there are more in the United States than Europe, artificially inflates survival time, experts said.

Read the full article here.

// Follow Read This, Not That on Tumblr / Facebook / Twitter //

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