Just what the doctor ordered?
The White House this month asked states to end criminalization of HIV transmission. Basically, these laws make it a crime for anyone who knows they have HIV to engage in activities that could transmit the disease to others (unless informed consent is given). According to the White House:
In many instances, the continued existence and enforcement of these types of laws run counter to scientific evidence about routes of HIV transmission and may undermine the public health goals of promoting HIV screening and treatment. CDC data and other studies tell us that intentional HIV transmission is atypical and uncommon. A recent research study also found that HIV-specific laws do not influence the behavior of people living with HIV in those states where these laws exist.
The entire argument here appeals to “public health goals,” a broadly consequentialist notion about overall health of the community. But perhaps the justification for these laws can be found elsewhere.
After all, the state has a responsibility to protect individuals from the negligence of others, and this law may be an expression of this responsibility. This protection can have societal costs, but non-consequentialists might argue that the rights of the individual trump these concerns – the protection of individuals from others is still the first responsibility of the state, morally prior to protecting citizens from, for example, diseases and poor health.
-Han
Photo by Flickr user Trygve.u used under a Creative Commons Attribution license.
I’m not racist, I have lots of friends who are pale
The Washington Post has a ridiculously amazing article on people who think that the “tan tax”, a provision of the health care reform bill charging a 10 percent surcharge on the use of tanning beds, constitutes racism against — yeah, that’s right — pale-skinned people (or is it pigment-challenged Americans?):
The case can seem deceptively simple: Since patrons of tanning salons are almost exclusively white, the tax will be almost entirely paid by white people and, therefore, violates their constitutional right to equal protection under the law.
But does the argument have any merit? Not remotely said Randall Kennedy, a professor at Harvard Law School specializing in racial conflict and law. “There is no constitutional problem at all, because a plaintiff would have to show that the government intended to disadvantage a particular group, not simply that the group is disadvantaged in effect…. To say that this health rationale was a mere pretext for wanting to stick it to white people is completely implausible.”
-Marc
Photo by Flickr user Whatshername? used under a Creative Commons Attribution license.
Paying people to be healthy
The New York Times’ Room for Debate blog has a fascinating discussion on programs that encourage people to become and stay healthy. A panel that includes policy analysts, a doctor and a professor of bioethics consider whether incentive programs work and whether they raise ethical questions or alter the sacred doctor-patient relationship. Check out the full debate here.
Is there a states’ rights issue in the Affordable Care Act?
Chicago labor lawyer Thomas Geoghegan has a piece in Politico debunking the legal claims made by state attorneys general against the Affordable Care Act. Geoghegan’s most persuasive argument is that the voluntary nature of Medicare puts conservative lawyers in a poor predicament. Geoghegan pounces:
Now, the state attorneys general anticipate this annoying quibble. Their complaint has a paragraph that, in effect, says: “OK, we know it’s voluntary. But we’re invested in the old Medicaid rules, and we can’t just leave the program now.”
In other words, if a state voluntarily participates in a federal program, it has a 10th Amendment right to have the federal government implement the program exactly the way the state wants. Implicit here is the claim that the federal government cannot change any welfare program that goes through a state — unless the state agrees.
The idea of “states’ rights” is thought to be at the core of the conservative argument against ACA. But it seems like states have already quite voluntarily delegated much of their health care responsibility quite happily to the federal government. Geoghegan reminds us that the key reason Texas or any other state would not and cannot actually secede is that they would be cut off from the flood of federal entitlement money that’s critical to keeping their operations afloat. The federalism argument plays well on TV, but ultimately the discussion is just about the level at which a particular federal program should be funded.
-John
The blame game
How to talk about blame with diseases like AIDS?
In Tuesday’s NY Times Infectious-disease physician Abigal Zuger writes that it is time to move beyond “obsolete H.IV. statues” that seek to punish those who transmit the disease. She explains that our fascination with playing the blame game over the spread of AIDS is representative of a larger human desire to hold someone else responsible for our illness:
We blame that coughing woman in the subway for our cold, the giant meat company for our food poisoning, all manner of chemicals and electromagnetic radiation for our cancers, and fast-food outlets for our diabetes and heart disease. We cannot experience illness without casting around for blame.
Zuger is certainly correct that the spread of AIDS cannot be distilled into simple terms like innocent victim and murderous sexual deviant. The disease often “moves among the poorest of the poor, the disenfranchised and socially marginalized, where substandard education means no escape.” Read more
Tea Partyers for Medicare
Inconsistency or philosophical conservatism?
The New York Times had a fascinating look yesterday at the demographic and ideological makeup on the Tea Party movement. Long discussed, but little studied, The New York Times and CBS commissioned a poll this month to get a detailed look at the profile and attitudes of Tea Party supporters.
The poll found that the 18 percent of Americans who associate with the Tea Party movement tend to be white, male, married, over 45 and on the “very conservative” end of the ideological spectrum. Tea Partyers express “fierce animosity toward Washington, and the president in particular, [ ] rooted in deep pessimism about the direction of the country and the conviction that the policies of the Obama administration are disproportionately directed at helping the poor rather than the middle class or the rich.”
But here’s the surprising stuff. While Tea Party supporters believe the goal of their movement is reduce the size of government and favor doing so even if it means cutting domestic programs, most happily partake in the three most expensive domestic programs: public education, medicare and social security. And they assert that these programs are “worth the cost to taxpayers.”
So what gives? Read more
Guest post: Majority rules?
Opinion polls and democratic decision making
Anyone watching the recent health care vote on C-SPAN heard the same refrain from the Republican opposition: the healthcare bill (now law) is morally wrong because a majority of Americans oppose it. Many conservatives made this argument during the year-long slog, citing public opinion polls for support. Indeed, across the political spectrum public opinion polls are regularly used as a defense for or against particular legislation or government actions. But what do opinions polls really tell us? And what role should they have in deciding how we as a political society should act?
The impulse to invoke public opinion as a moral basis for democratic actions is understandable. Citizens in democracies are self-ruling. Acting contrary to the majority opinion is often seen as violating the public will. And opinion polls are as close as we can get in the short term at least, to taking the temperature of the public. Elections are held periodically, but they can only stop perceived injustices after the fact. For instance, assume Congress passes a wildly unpopular bill. It may take upwards of two years before the electorate can voice its disapproval through elections. But after two years, the damage may already be done. It is difficult to retroactively repair injustices. Opinion polls are all we have to assess the public will on a bill by bill basis.
But do opinion polls actually tell us the public will?
Buy this, citizen!
Constitutionally speaking, can Congress force individuals to purchase health insurance? Discussion at the Washington Post blog.
-Jake
Health care overload: whither inequality?
David Leonhardt’s “Economic Scene” column in today’s New York Times, entitled “In Health Care Bill, Obama Attacks Wealth Inequality,” is a must-read.
Equality, particularly of resources, is a much more popular topic among political philosophers than among politicians. After we get past the idea that all people are created equal, Americans tend to have an ambivalent relationship with equality and what it entails.
Many prize the value of personal responsibility and believe that inequality driven by working harder and better is, in some ways, a sign that our entrepreneurial capitalist system is working.
In debates about social welfare, discussions of inequality are largely veiled. Addressing poverty or promoting economic opportunity garner broader support than “narrowing income equality” or “redistributing wealth.”
Whether or not they arrive at similar conclusions, political philosophers tend to be much more candid about what’s really at stake in these discussions: equality (what kind, how important, by what means?). That’s a good thing. It’s one reason we have political philosophy–to introduce clarity to public debate over values.
Although no one has really mentioned it until now, David Leonhardt makes clear that the health care bill is the biggest, most active federal effort to promote equality in almost 50 years:
The bill is the most sweeping piece of federal legislation since Medicare was passed in 1965. It aims to smooth out one of the roughest edges in American society – the inability of many people to afford medical care after they lose a job or get sick. And it would do so in large measure by taxing the rich.
A big chunk of the money to pay for the bill comes from lifting payroll taxes on households making more than $250,000. On average, the annual tax bill for households making more than $1 million a year will rise by $46,000 in 2013, according to the Tax Policy Center, a Washington research group. Another major piece of financing would cut Medicare subsidies for private insurers, ultimately affecting their executives and shareholders.
The benefits, meanwhile, flow mostly to households making less than four times the poverty level – $88,200 for a family of four people. Those without insurance in this group will become eligible to receive subsidies or to join Medicaid. (Many of the poor are already covered by Medicaid.) Insurance costs are also likely to drop for higher-income workers at small companies.
Love it or hate it, health care reform is a big deal. The real question is whether it promotes the society we want, or erodes the one we have. Or both.
-Sam
Was health care reform illegal?
The Washington Post yesterday described the intention of the Virginia Attorney General Ken Cuccinelli to challenge the health care reform bill in court by arguing that requiring individuals to purchase health care – the individual mandate — exceeds the federal government’s authority to regulate interstate commerce. Today, liberal health care blogger Ezra Klein investigates whether or not Cuccinelli has a legitimate legal case against the health care bill.
-Marc
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