Our Editorial in the New York Times: “We Stand For Access”

As a member of the American Society of Law, Medicine & Ethics, I’m proud to add my name to this letter to the editor in the New York Times:

To the Editor:

We, many of the nation’s health law and health policy professors from law, medical, public health and graduate schools across the United States, write to address one of the most fundamental issues impacting our country: the potential repeal and replacement of the “Affordable Care Act” (“Obamacare”). It is clear that the House-passed “American Health Care Act,” as well as the legislation likely to be considered by the Senate, will cause severe, lasting harm to all of us, especially our society’s most vulnerable and middle class.

Today we raise our voices to oppose these proposals. While the Affordable Care Act has its shortcomings that should be fixed, the current proposals are merely “repeal,” with no effective “replace.” These proposals are wrong, and must be rejected. At a time when we are seeing significant declines in the number of uninsured and inadequately insured in our country, the House and Senate proposals represent a giant step backward. By cutting Medicaid funding, eliminating federal assistance for families securing private coverage, and encouraging individuals to either not purchase insurance or to buy barebones coverage, these proposals will result in a less equitable, less accessible system of health care. Ultimately, the public’s health will decline as needed care is forestalled or not sought, and costs will rise as a shrinking pool of Americans with “good” insurance pay more to subsidize those without.

Given the many health care challenges that we face— an aging population needing an increasing amount of health care services; a young and middle age population facing growing rates of obesity, heart disease, and other chronic conditions; a rapidly expanding “gig” economy of independent contractors needing to secure insurance without employer subsidies; and a rising number of individuals addicted to new and more prevalent illegal drugs— reducing access to health care services simply cannot be an acceptable policy option.

We also are deeply concerned about what this new legislation portends for women and children. Currently, the United States leads the developed world in maternal mortality. More women die during childbirth in the United States than in any other Western nation. Despite the urgency to protect women’s health and strive for better outcomes, lawmakers have specifically targeted maternal health coverage for cuts.

The same is true for infants in the U.S, whose health care is also at risk with these proposals. Our nation ranks 50th in the world on infant mortality. By shifting more families off of Medicaid, and creating a larger uninsured and under-insured population, children’s access to health care services will decline.

The Affordable Care Act protects all Americans from discrimination based on preexisting conditions, expands coverage for mental health treatment and drug addiction, and fosters preventive care. Millions of Americans have health insurance for the first time, and we are at an all-time low in the percentage of citizens who lack coverage. The reform legislation under development proposes to wipe away these essential gains, returning Americans to the pre-Affordable Care Act era of coverage limitations and exclusions thwarting the provision of essential health care services.

In 1966, Dr. Martin Luther King explained to a group of health providers, “Of all the forms of inequality, injustice in health is the most shocking and inhumane.” We agree.

Reader Requests: Why Aren’t We Prosecuting Fraud?

A reader asks: Each year American taxpayers lose billions of dollars to fraud, yet nobody in Washington wants it stopped. Why?

Yes, fraud is a continual challenge with government programs. However, it’s not true that nobody in Washington wants it stopped. The Patient Protection and Affordable Care Act of 2010 (a.k.a. “Obamacare”) improved the government’s ability to detect and crack down on Medicare fraud. As a result, earlier this year, the Obama administration announced the largest anti-fraud takedown in history, totaling $452 million. The Obama administration has also tried to increase the IRS’s budget to crack down on tax fraud, but Republicans in Congress blocked it. The IRS estimates that they can collect an additional $200 in tax revenue for each dollar added to their budget. They know how to combat fraud. They just don’t have the resources to do so.

In response, another reader asks: Do you know why Republicans blocked it?

They want to cut the budgets of all the major regulatory agencies. They’re fanatically opposed to regulation, and they don’t want to collect more tax revenue, even if it means letting cheaters get away with their crimes. They want to “shrink [the government] down to the size where we can drown it in a bathtub,” as one of their leading lobbyists famously said.

Many of them campaigned on eliminating the IRS altogether. “Getting rid of the IRS is something we’d all love,” said Mitt Romney in a 2007 primary debate. They’ve been waging this war since the 1990s, when the Republican Senate leaders compared the IRS to the Nazi secret police.

It’s also worth noting that the rich have the most to gain from lax tax enforcement. They can afford accountants who hide their income in dubious tax shelters, a luxury not available to the poor or middle class. In the Republican mindset, the rich are producers and the rest are moochers, so anything the rich do to avoid paying taxes is their right as the anointed kings of capitalism.

Ya Got Trouble, Folks!

by Norman Horowitz

Ya got trouble, folks, right here in River City
With a capital ‘T’ and that rhymes with ‘P’
And that stands for ‘pool’

— The Music Man

I know it’s an arcane notion that we are, in theory, a nation of laws.

Due process, to name but one, is guaranteed under the Fifth Amendment:

No person shall…be deprived of life, liberty, or property, without due process of law…

And the Fourteenth Amendment:

No State shall…deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

Due process generally requires fairness in government proceedings. A person is entitled to notice and opportunity to be heard at a hearing when they have life, liberty, or property at stake.   Continue reading “Ya Got Trouble, Folks!”