inequity « Berman Institute Bioethics Bulletin

In an unexpected move, the Justice Department filed a brief this evening urging a Texas court to invalidate the Affordable Care Act’s crucial insurance reforms—including the prohibition on refusing to cover people with preexisting conditions. Although the ACA is not in immediate peril, the brief represents an enormous blow to the integrity of the Justice Department. It also displays enormous contempt for the rule of law.

For those of you just coming to the case, this is from my earlier recap:

In their complaint, the states [including Texas and other red states] point out (rightly) that the Supreme Court upheld the ACA in NFIB v. Sebelius only because the individual mandate was a tax and (rightly) that Congress has now repealed the penalty for going without insurance. As the states see it, the freestanding requirement to get insurance, which is still on the books, is therefore unconstitutional. Because it’s unconstitutional, the courts must invalidate the entire ACA—lock, stock, and barrel.

…continue reading ‘Texas Fold ‘Em’

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The Incidental Economist

Another Cause of Doctor Burnout? Being Forced To Give Immigrants Unequal Care

May 22, 2018

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Another Cause of Doctor Burnout? Being Forced To Give Immigrants Unequal Care

Tuesday, May 22nd, 2018

One patient’s death changed the course of Dr. Lilia Cervantes’ career. The patient, Cervantes says, was a woman from Mexico with kidney failure who repeatedly visited the emergency room for more than three years. In that time, her heart had stopped more than once, and her ribs were fractured from CPR. The woman finally decided to stop treatment because the stress was too much for her and her two young children. Cervantes says she died soon after.

Kidney failure, or end-stage renal disease, is treatable with routine dialysis every two to three days. Without regular dialysis, which removes toxins from the blood, the condition is life threatening: Patients’ lungs can fill up with fluid, and they’re at risk of cardiac arrest if their potassium level gets too high.

But Cervantes’ patient was undocumented. She didn’t have access to government insurance, so she had to show up at the hospital in a state of emergency to receive dialysis.

…continue reading ‘Another Cause of Doctor Burnout? Being Forced To Give Immigrants Unequal Care’

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NPR Shots

The Obesity Cure Is Out of Reach in the Heaviest States

May 7, 2018

Bariatric surgery works, but hundreds of thousands of eligible patients can’t get it

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The Obesity Cure Is Out of Reach in the Heaviest States

Monday, May 7th, 2018

In Mississippi, more than 37 percent of adults are obese, making it the second-most obese state in the nation. But Mississippi is also one of two states, along with Montana, that doesn’t cover bariatric surgery in its Medicaid program, which serves 760,000 people.

One popular type of bariatric surgery, the gastric sleeve, costs between $20,000 and $35,000 without insurance, experts told me. It shrinks the stomach to about the size of a banana, changing the body’s hunger hormones and reducing a person’s natural weight—one they don’t have to starve themselves to stick to. For the morbidly obese, diet and exercise don’t usually have this same effect on their own. (People who lost hundreds of pounds sweating it out on the TV show The Biggest Loser, for example, tended to gain it all back.)

… continue reading ‘The Obesity Cure Is Out of Reach in the Heaviest States’

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The Atlantic

A Simple Way to Improve a Billion Lives: Eyeglasses

May 7, 2018

It’s the biggest health crisis you’ve never heard of. Doctors, philanthropists and companies are trying to solve it

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A Simple Way to Improve a Billion Lives: Eyeglasses

Monday, May 7th, 2018

PANIPAT, India — Shivam Kumar’s failing eyesight was manageable at first. To better see the chalkboard, the 12-year-old moved to the front of the classroom, but in time, the indignities piled up.

Increasingly blurry vision forced him to give up flying kites and then cricket, after he was repeatedly whacked by balls he could no longer see. The constant squinting gave him headaches, and he came to dread walking home from school.

“Sometimes I don’t see a motorbike until it’s almost in my face,” he said.

…continue reading ‘A Simple Way to Improve a Billion Lives: Eyeglasses’

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NY Times

She Didn’t Get Treated at the ER. But She Got a $5751 Bill Anyway.

May 1, 2018

Vox’s emergency room database shows that patients can face steep bills even when they decline treatment

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She Didn’t Get Treated at the ER. But She Got a $5751 Bill Anyway.

Tuesday, May 1st, 2018

On October 19, 2016, Jessica Pell fainted and hit her head on a nearby table, cutting her ear. She went to the emergency room at Hoboken University Medical Center, where she was given an ice pack. She received no other treatment. She never received any diagnosis. But a bill arrived in the mail for $5,751.

“It’s for the ice pack and the bandage,” Pell said of the fee. “That is the only tangible thing they could bill me for.”

Pell’s experience is not unique. Submissions to Vox’s ER database project found multiple examples of ERs charging patients hundreds or even thousands of dollars for walking through the door. Some never got past the waiting room. Some were triaged, but none received treatment from a doctor.

… continue reading ‘She Didn’t Get Treated at the ER. But She Got a $5751 Bill Anyway.’

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VOX

Injecting Drugs Can Ruin a Heart. How Many Second Chances Should a User Get?

April 30, 2018

A life-threatening heart infection afflicts a growing number of people who inject opioids or meth. Costly surgery can fix it, but the addiction often goes unaddressed

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Injecting Drugs Can Ruin a Heart. How Many Second Chances Should a User Get?

Monday, April 30th, 2018

OAK RIDGE, Tenn. — Jerika Whitefield’s memories of the infection that almost killed her are muddled, except for a few. Her young children peering at her in the hospital bed. Her stepfather wrapping her limp arms around the baby. Her whispered appeal to a skeptical nurse: “Please don’t let me die. I promise, I won’t ever do it again.”

Ms. Whitefield, 28, had developed endocarditis, an infection of the heart valves caused by bacteria that entered her blood when she injected methamphetamine one morning in 2016. Doctors saved her life with open-heart surgery, but before operating, they gave her a jolting warning: If she continued shooting up and got reinfected, they would not operate again.

With meth resurgent and the opioid crisis showing no sign of abating, a growing number of people are getting endocarditis from injecting the drugs — sometimes repeatedly if they continue shooting up. Many are uninsured, and the care they need is expensive, intensive and often lasts months. All of this has doctors grappling with an ethically fraught question: Is a heart ever not worth fixing?

…continue reading ‘Injecting Drugs Can Ruin a Heart. How Many Second Chances Should a User Get?’

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NYTimes

Infant Deaths Fall Sharply in Africa With Routine Antibiotics

April 26, 2018

Two doses a year of an antibiotic can sharply cut death rates among infants in poor countries, perhaps by as much as 25 percent among the very young, researchers reported on Wednesday

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Infant Deaths Fall Sharply in Africa With Routine Antibiotics

Thursday, April 26th, 2018

Their large study — of nearly 200,000 children in three African countries — raises the exciting possibility that deploying antibiotics as doctors do vaccines could rapidly reduce deaths among newborns and infants. Death rates in this age group have remained stubbornly high in poor countries even as deaths among all children under age 5 have dropped by half, thanks to vaccines against childhood diseases.

As a result of the study, the World Health Organization is considering whether to recommend routinely giving antibiotics to newborns.

“Our independent expert panel says this holds a lot of promise,” said Dr. Per Ashorn, a W.H.O. expert in maternal and child health. “But we will review it with very rigorous procedures.”

…continue reading ‘Infant Deaths Fall Sharply in Africa With Routine Antibiotics.’

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NYTimes

Clear Signs of Global Warming Will Hit Poorer Countries First

April 20, 2018

New climate-inequality tool quantifies how quickly the weather will veer beyond normal in different regions

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Clear Signs of Global Warming Will Hit Poorer Countries First

Friday, April 20th, 2018

Nations such as Bangladesh and Egypt have long known that they will suffer more from climate change than will richer countries, but now researchers have devised a stark way to quantify the inequalities of future threats.

A map of “equivalent impacts”, revealed at the annual meeting of the European Geosciences Union (EGU) this month in Vienna, shows that global temperatures would have to rise by a whopping 3 °C before most people in wealthy nations would feel departures from familiar climate conditions equal to those that residents of poorer nations will suffer under moderate warming.

The Paris climate agreement, adopted by 195 countries in 2015, aims to limit the rise in global mean temperature to 1.5–2 °C above pre-industrial levels. The world has already warmed by one degree or so — and since 1900, the mean number of record-dry and record-wet months each year has also increased.

… continue reading “Clear signs of global warming will hit poorer countries first”

Image: NASA

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Nature

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Texas Fold ‘Em

Texas Fold ‘Em

Another Cause of Doctor Burnout? Being Forced To Give Immigrants Unequal Care

Another Cause of Doctor Burnout? Being Forced To Give Immigrants Unequal Care

The Obesity Cure Is Out of Reach in the Heaviest States

The Obesity Cure Is Out of Reach in the Heaviest States

A Simple Way to Improve a Billion Lives: Eyeglasses

A Simple Way to Improve a Billion Lives: Eyeglasses

She Didn’t Get Treated at the ER. But She Got a $5751 Bill Anyway.

She Didn’t Get Treated at the ER. But She Got a $5751 Bill Anyway.

Injecting Drugs Can Ruin a Heart. How Many Second Chances Should a User Get?

Injecting Drugs Can Ruin a Heart. How Many Second Chances Should a User Get?

Infant Deaths Fall Sharply in Africa With Routine Antibiotics

Infant Deaths Fall Sharply in Africa With Routine Antibiotics

Clear Signs of Global Warming Will Hit Poorer Countries First

Clear Signs of Global Warming Will Hit Poorer Countries First

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