Tag: Health Care Policy

Blog Posts (15)

December 13, 2016

Imminent Threats To Healthcare and Medical Professionalism: We Must Remain Vigilant

In a previous blog I expressed concerns about the possible direction of politics in our country and the risks it poses to the larger procedural, democratic framework, which I take to be essential to the work of contemporary bioethics. Now that the election is over and a new administration is taking shape, I have many grave concerns about the fundamentally new policy directions our nation will be taking. None concern me more than how the planned changes in our healthcare system in the United States and, if they happen, how our most vulnerable patients will be affected. This is because a top agenda for them on day one will be to repeal the Affordable Care Act (ACA), which has provided healthcare coverage for about 21 million more people since its inception in 2009.

The ACA was an imperfect healthcare plan from the start. But after decades of false starts to reform a system that does not have a close second in terms of excessive costs and inefficiencies among industrialized nations, especially in relation to outcomes, in 2009 it was the best option our country had at that time. In spite of some problems in its implementation, due largely to lack of cooperation and critics setting up obstacles, the ACA has become entrenched into our healthcare system. If it is repealed, there will be widespread suffering and chaos. Just recently the nations’ hospital industry “…warned President-elect Donald Trump and congressional leaders on Tuesday that repealing the Affordable Care Act could cost hospitals $165 billion by the middle of the next decade and trigger “an unprecedented public health crisis.”

 The eagerness of the new administration to gut the ACA was affirmed by the appointment of Tom Price, Representative from Georgia who has been a ferocious and over the top critic of this law from its inception. A prominent orthopedic surgeon prior to running for Congress, Dr. Price seems to advocate for a system that is extricated from government as much as possible and placed in the hands of the private insurance companies. His plan, which provides for individual fixed tax credits and health savings accounts and allows insurance companies to cross state lines, may be helpful for many Americans who are relatively well off and have healthcare to start with. But for most of the sickest patient in lower income brackets, these market-based ideas will do nothing to help them and in fact make them worse off. But real world, harmful consequences are the concerns of an ideologue: All that matters is having in place a policy that accords with an ideal vision of how the world should work.

There is no practical way that a purely market based approached to providing access to healthcare to Americans will accomplish the goals of healthcare that the majority of Americans have, which is to provide some type of basic, quality healthcare to all citizens, at an affordable cost. Price’s approach will leave millions of American citizens, many already with serious health problems without access to health except via the emergency rooms. The predictable consequences will be astronomically increasing costs because healthcare will retreat to its pre-ACA days of inefficiency by focusing more on rescuing patients from acute conditions than preventing them from occurring in the first place; and physicians caring for patients with insurance will be doing more and more procedures for which they will be handsomely paid, without improving quality for patients. Which makes it all the sadder to see the American Medical Association (AMA), as it has done at prior critical historical junctures as it did in standing against the passage of Medicare and Medicaid in 1965, endorsing Price’s nomination.

Though Price’s nomination may be bad for patients, it likely represents good news for physicians in terms of their incomes from reimbursement rates. Which is the reason why the AMA supports him and why, in my judgment, it is an abdication of professional, ethical good judgment and responsibility. Their support violates the basic tenant of professionalism as stated in the American College of Physicians (ACP) Ethics Manual that require its members “…to teach and expand, by a code of ethics and a duty of service that put patient care above self-interest, and by the privilege of self-regulation granted by society. Physicians must individually and collectively fulfill the duties of the profession.”

I am heartened by practicing physicians and physicians-in-training who speak out and refuse to be a part of the AMA and its support of Price’s appointment to be Secretary of HHS.  Most notably a petition has gained over 5,000 physicians’ signatures that make it clear “The AMA Does Not Speak For Us”.  As they state in the petition:

 

“We are practicing physicians who deliver healthcare in hospitals and clinics, in cities and rural towns; we are specialists and generalists, and we care for the poor and the rich, the young and the elderly. We see firsthand the difficulties that Americans face daily in accessing affordable, quality healthcare. We believe that in issuing this statement of support for Dr. Price, the AMA has reneged on a fundamental pledge that we as physicians have taken?—?to protect and advance care for our patients.”

 

Medical professionalism always exists in relationship to the prevailing economic and political order in society. Because economic and political winds can shift, so can medical professionalism that at times can put it at risk of losing its moral compass. We do not know yet just how strong the head winds will be. But medical professionals and all citizens who care about the future of just and quality healthcare should be especially vigilant in the coming days and remain prepared to show resistance when necessary.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

September 16, 2016

Outside the Comfort Zone

I always feel a little nervous for the folks who sign up to be contestants on “Dancing with the Stars” because despite any prior fame or achievements they are spectacularly and uniquely vulnerable on the dance floor. Stepping outside their comfort zone is perhaps what we admire about these celebrities – they are suddenly vulnerable to a different and unfamiliar scrutiny. Mastering new skills alongside an assigned partner we hope for the best as the dancers put their best effort on display. There are criteria to be satisfied (need to show enough Viennese Waltz and Foxtrot moves), and judges to score how well they met these standards. While there is no small amount of entertainment value to the evaluation of the contestants, what is interesting is that the public votes too. This may be a reach, but as healthcare faces new standards measuring quality under the ACA, we see some interesting parallels.

Like our intrepid celebrity dancers, healthcare institutions need to adapt to an evolving set of quality measurements under the ACA. As healthcare institutions brace for the uncertain impact of the ACA regulations on the day to day operations and finances, those responsible for assuring the delivery of care are focusing on not only the cost per patient, but also on improving how patient experience care, and how the health of the community at large can be improved. Like the dancers finding their footing, the ACA challenges the healthcare industry to serve patients with agile and efficient practices in order to not be left behind. An increased the number of patients who now have access to health insurance coverage in states with expanded Medicaid; there is good reason to anticipate a continued increase in the demand for healthcare services. At the same time, the ACA reimbursement requires added accountability for healthcare outcomes, packaged as a blend of incentives and penalties.  An article published in the Annals of Internal Medicine in 2014 (Ryan AM and Mushlin AI. The Affordable Care Act’s Payment Reforms and the Future of Hospitals, Ann Intern Med: 2014; 160(10): 729-730) reminds us that the US healthcare system has navigated change before, and will likely be able to do so again, though the initial phases may require tolerating uncertainty and fiscal caution. We will have to step outside the comfort zone, hope for skilled partners in healthcare leadership, and giving our best effort.

August 9, 2016

Why Is Getting Healthcare Coverage So Hard?

For a great nation like the United States, it is not only embarrassing, but also morally reprehensible that there are still millions of American citizens who in principle could have healthcare coverage but are being denied that benefit for purely political reasons. Ideologically driven governors in Red states would rather defy the efforts of President Obama to expand healthcare coverage for all their citizens than provide this most basic human service to their citizens. I draw this conclusion simply because their alleged reason for refusing to expand Medicaid—that expanded coverage will be unaffordable—is simply not true. With Medicaid expansion, the federal government will significantly underwrite most of the costs and without states are on their own in the most inefficient healthcare system possible—they get no access to basic primary care but if they get acutely sick they can show up at an ER and utilize the system at time where cost is exorbitant and goals are limited. It is an abomination how healthcare has been a political football for decades while people with medical needs are allowed to suffer and die.

 

But it is not just patients without healthcare coverage who lack access to medical care—it is also millions of patients with coverage. Medicaid currently covers over 70 million Americans, yet many of these patients are not able to find a physician who will accept them. In a 2011 national survey of physicians, 31% were unwilling to accept Medicaid patients; in certain states the rates are much higher—for example, in New Jersey only 40% of physicians accepted Medicaid patients. When reimbursement rates are increased, these rates of physicians willing to accept Medicaid patients also rise. Clearly if we are going to expand healthcare coverage in the United States, we must ensure that physicians are provided a fair reimbursement for the services. But there are other barriers other than reimbursement.

 

Another important barrier is the fact that many poor patients live in areas of the country where there are shortages of physicians. Up to 60% of the underserved areas in need of primary care physicians are in non-metropolitan areas. Physicians’ reticence to work in areas with high concentrations of patients whose primary insurance coverage can be partly explained by lower than average compensation rates but not entirely. Other barriers may include most physicians wanting to live in metropolitan areas and not wanting to deal with more patients with complex issues, such poverty and poor education. Moreover, physician specialist simply make much higher incomes in larger metropolitan areas. In the past the choices of individual physicians coincided with the general health needs of society. It appears that in today’s society, there are serious health needs of large segments of society going unmet.

 

But even in Blue states like California, with Medicaid expansion, many patients have what looks like good health care coverage and yet are often unable to find a physician or qualified health care professional to meet their needs. This is particularly problematic for patients with mental health issues. A recent story on NPR about a mom with a 12 year-old son provides a great illustration. To start with this mom is forced to pay high copays of $75 per session for needed therapy for her son—for working people, living on pay check to pay check, serious health needs can easily go unaddressed. The 2008 Mental Health Parity Act and the Affordable Care Act (ACA) insurance companies attempted to fix some of the problems like preventing insurance companies from charging higher copays for mental health services than other services. But insurance companies still find ways to skirt the law “sometimes through subtle, technically legally, ways of limiting treatment.” The mom in this story discovered one of those ways when she tried to schedule an appointed with one of the therapists her insurance company would cover for a lower copays of $20. The problem was there were no therapists willing to accept her son. The insurance companies are at least superficially in compliance with the law, but there are no therapists, or very few, that are available for new patients. Part of the problem is that millions of new patients with mental health issues have signed up under the ACA, have coverage, but cannot find a qualified healthcare professional to care for them.

 

The problems to which I have alluded are characteristic of a healthcare system filled with inefficiencies and bloated costs. There are many reasons to account for why these inefficiencies exist, which I won’t get into here. But as a medical educator, I am reminded of the Physician’s Charter from the American Board of Internal Medicine (ABIM), which embraces a bold, robust set of professional obligations charging physicians to expand access to medical care for all patients and to promote social justice. Under the heading of Social Justice, it states: “The medical profession must promote justice in the health care system, including the fair distribution of health care resources.”

 

At my medical school we are teaching our new physicians they have an obligation to advocate for all patients and help expand access to healthcare. I must admit I am worried that the challenges they will face will be nearly insurmountable without significant change at the political level and many other policy changes, like greater parity in incomes between specialists and primary care physicians and tuition debt relief. But, patients, which includes all voters, must do our part too as citizens involved in the political process and support candidates that in turn support access to quality public healthcare for everyone. These concerns should weigh heavily in the choices we make at the voting booth this fall. Getting basic healthcare coverage for all citizens should not be this hard.

 

 

 

October 5, 2015

Elective or Life-Saving? Catholic Hospitals and the Ban on Tubal Ligation

<p style="font-size: 11.2px; line-height: 19.04px;"><span style="font-size: 11.2px; line-height: 19.04px;">A Catholic hospital </span><a style="font-size: 11.2px; line-height: 19.04px;" href="https://www.rt.com/usa/315359-catholic-hospital-denies-sterilization-request/">came under fire recently</a><span style="font-size: 11.2px; line-height: 19.04px;"> for stating that it would not permit doctors to perform a tubal ligation during a c-section scheduled for October.  According to news reports (including an</span><a style="font-size: 11.2px; line-height: 19.04px;" href="http://www.thedailybeast.com/articles/2015/09/23/a-catholic-hospital-says-it-s-evil-for-me-to-get-my-tubes-tied.html">article written by the patient herself</a><span style="font-size: 11.2px; line-height: 19.04px;">), the pregnant patient has a brain tumor, and her doctor have advised her that another pregnancy could be life-threatening.  Her doctor has recommended that she have a tubal ligation at the time of her c-section.  While my knowledge about this hospital, this case, and the participants is limited to what has been reported in the media, it raises an interesting question: in our pluralistic society, where conscientious objection is respected while maintaining a patient’s right to a certain standard of care, is it ethical to allow a religiously-affiliated health care institution to refuse to provide certain treatments it finds morally objectionable?</span></p> <p style="font-size: 11.2px; line-height: 19.04px;"><span style="font-size: 11.2px; line-height: 19.04px;">As background, the Catholic Church has historically been outspoken on bioethical issues and has a strong and robust bioethical teaching.  Catholic hospitals are governed by the </span><a style="font-size: 11.2px; line-height: 19.04px;" href="http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf">Ethical and Religious Directives for Catholic Health Care Services</a><span style="font-size: 11.2px; line-height: 19.04px;"> (ERDs), a document promulgated by the United States Conference of Catholic Bishops (USCCB) that clearly articulates the bioethical policies that must be followed in a health care institution based on the Church’s moral teachings.  It explains the Church’s teaching against direct sterilization as a method of birth control based on the </span><a style="font-size: 11.2px; line-height: 19.04px;" href="http://plato.stanford.edu/entries/double-effect/">principle of double effect</a><span style="font-size: 11.2px; line-height: 19.04px;">.  “Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution.  Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.” (Directive 53).  In other words, if the sterilization procedure directly treats a pathology, it is licit; if it is used as a form of birth control to prevent a pregnancy, even if that pregnancy would be life-threatening, it is not licit.</span></p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
September 4, 2015

Are Primary Care Providers Providing Primary Care?

<p class="MsoNormal" style="font-size: 11.2px; margin-bottom: 0.0001pt; line-height: normal;"><span style="font-size: 11.2px;">I initially set out to write a post about lack of access to primary care physicians, but the more I explored the topic, the more I realized that the issue is not only that access to PCPs is limited, but that the medical model of primary care itself has changed.</span></p> <p class="MsoNormal" style="font-size: 11.2px; margin-bottom: 0.0001pt; line-height: normal;"><span style="font-size: 11.2px;">It has been widely discussed among bioethicists and health care policy experts that emergency departments are overcrowded, urgent care centers are rapidly</span><a style="font-size: 11.2px;" href="http://registerguard.com/rg/news/local/33331415-75/ccundoctored-sidebar-hedliney-herey.html.csp">becoming a substitute for the traditional primary care doctor</a><span style="font-size: 11.2px;">, and that the number of new physicians specializing in primary care medicine has been declining </span><a style="font-size: 11.2px;" href="/BioethicsBlog/post.cfm/what-we-can-learn-from-medical-students-about-the-need-for-health-care-reform-in-the-u-s">in favor of other, higher-paying specialties</a><span style="font-size: 11.2px;">.</span><span style="font-size: 11.2px;">  </span><span style="font-size: 11.2px;">Still, many insurance plans require regular visits with a PCP and only cover specialty services if the referral is made by the patient’s primary doctor.</span><span style="font-size: 11.2px;">  </span><span style="font-size: 11.2px;">Specialists and urgent care clinicians also insist that patients follow up with their PCP after treatment and make sure that their records are forwarded.</span><span style="font-size: 11.2px;">  </span><span style="font-size: 11.2px;">Despite the push for establishing a “medical home” and centralizing care around the primary care physician, demand for urgent care or emergency services is still high, and getting into a practice or getting a timely appointment with a primary care physician is difficult.</span></p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; line-height: 19.04px; font-size: 12px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; line-height: 19.04px; font-size: 12px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
May 14, 2015

Why Do We Over Treat Patients in the U.S.?

<p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">As a clinical ethics consultant and bioethics professor for many years, it still amazes me that one of the most common problematic features of our healthcare system is the tendency to over treat patients to the point of causing harm and wasting financial resources. The question is, why?</span></p> <p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">The question, why do physicians generally over treat patients in the U.S., must be approached in light of the fact that we spend more per capita and more overall, about 16% of GDP, on healthcare and get far worse outcomes than do countries like Canada and Western European countries who spend far less of their GDP on healthcare. But to be fair, before we blame physicians entirely for making poor judgments about treatment options, it is important to keep in mind that the U.S. is big, diverse nation with complex social and economic issues where creating efficient systems of healthcare is both practically and politically challenging. Also the U.S. spends more on medical research than most other countries, which still benefits patients everywhere. But what is most uniquely American is an economic system designed by politicians first and foremost for creating wealth for investors and that provides, generally speaking, efficient markets for consumer goods and services. But, whatever the virtues of American capitalism in creating efficient markets, it does not hold true for healthcare.</span></p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; line-height: 19.0400009155273px; font-size: 12px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; line-height: 19.0400009155273px; font-size: 12px;"> </span><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 11.1999998092651px; line-height: 19.0400009155273px;"> </span></p>
March 12, 2015

The Unique Challenge of Healthcare Reform in the US, and Why it Might All Fall Apart

<p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Those of us who aspire to eventually having an affordable, quality, accessible healthcare system for all citizens, or even for most citizens, must first face an obvious but under-discussed challenge that uniquely American: The major players in the US healthcare system—including private insurance companies, pharmaceutical companies, medical device and equipment makers, medical specialties and sub-specialties, healthcare organizations and their executives and shareholders, and all of their lobbyists—are motivated by their own economic self-interests first and foremost. Which means our aspirations must be viewed as a long-term struggle.</span></p> <p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Healthcare in American is simply unfettered capitalism at work. Let me hasten to add, this is not to say that all of these entities don’t do some remarkable work—I owe my life to the U.S. healthcare system as do millions more. But the fact remains that much of the extravagantly high costs of medical care in the U.S. healthcare system has nothing to do with improving or adding quality care for patients and producing good outcomes. Rather it’s a reflection of how these key players pursue their own entrenched financial interests, while creating narratives to the public that the services they provide is essential for quality healthcare. Interestingly, over time, this bloated, inefficient system has been generally accepted by the public and therefore gained a façade of legitimacy that makes it virtually intractable to reform.</span></p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; line-height: 19.0400009155273px; font-size: 12px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; line-height: 19.0400009155273px; font-size: 12px;"> </span></p>
January 19, 2015

Why Buying A Car Is So Unlike Buying Healthcare

<p style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">Let’s say you are looking to buy a car. You think you might want to buy a Volvo so you go down to the Volvo dealer and check out the new models. But you are shocked by what you see. You realize that you really don’t need to spend $35 to $40,000, or more, on a new car, so you decide to visit the Subaru dealer. There you find very nice alternative models for thousands of dollars less. You are delighted to have a new Outback for about $27,000.</span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">The above story is how private markets and market choices work for the vast majority of items that we purchase to meet most of our needs as human beings. However, it has become painfully obvious that healthcare is an area where the normal model of markets and market choices do not apply. I’ll use a personal example.</span></p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;"> </span></p>
December 14, 2014

Patients Abandoned—Who is to blame?

<p style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">The vast majority of developed nations in the world provide universal healthcare coverage for its citizens. The only developed nations that do not are “…<a href="http://www.theatlantic.com/international/archive/2012/06/heres-a-map-of-the-countries-that-provide-universal-health-care-americas-still-not-on-it/259153/">a few still-troubled Balkan states, the Soviet-style autocracy of Belarus, and the U.S. of A., the richest nation in the world</a>.” </span></p> <p style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">Yet the United States (US) has the most expensive healthcare system in the world, by far—there really isn’t a close second—spending just under 18% of GPD and around $8,500.00 per person on healthcare. One might assume that given that type of expense, we would be getting a lot more than other countries in return for our investment. According to the research provided by <a href="http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror">Mirror, Mirror</a>, from the Commonwealth Fund, the US sadly underperforms and often fails relative to other developed countries on major measures of performance. </span></p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;"> </span></p>
October 10, 2014

Yes, Obamacare is a Success

<p><span style="line-height: 19.0400009155273px;">When the Affordable Care Act, commonly referred to as Obamacare was under consideration there was an unrelenting partisan attack against both the proposed legislation and the president who proposed it. We were told that millions would lose insurance coverage, that the cost of medical care would skyrocket, and that government bureaucrats would be interfering with the health care relationship between us and our physicians. We were told that death panels would be making decisions to end the life of the elderly and infirm. We were told all sorts of things that were so ridiculous that I cannot recall them. The fact is we were told lies. Interestingly and importantly none of these things have occurred. The Affordable Care Act was designed to increase the extent of medical insurance coverage and the corresponding access to health care permitted by insurance coverage. The Affordable Care Act was also designed to slow the growth of health care costs. While it is true that there were initial technical glitches in its rollout, now a year after people could begin to enroll, and still only months after the initiation of most of its provisions it is clearly apparent that it is doing just what it was designed and implemented to do. Yes, the Affordable Care Act, Obamacare, is a success.</span></p> <p><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a></strong></p>

View More Blog Entries