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Back Issues and Articles

Contents - JLME - 2008 Volume 36: 4
Table of Contents
  1. Table of Contents
Letter From The Editor
  1. Letter From The Editor
Symposium Articles
  1. On the Cusp: Insight and Perspectives on Health Reform
  2. America's Uninsured: The Statistics and Back Story
  3. Aiming High for the U.S. Health System: A Context for Health Reform
  4. Private Gain and Public Pain: Financing American Health Care
  5. Protect the Sick: Health Insurance Reform in One Easy Lesson
  6. There's "Private" and Then There's "Private": ERISA, Its Impact, and Options for Reform
  7. Why Public Programs Matter - and Will Continue to Matter - Even After Health Reform
  8. War, Its Aftermath, and U.S. Health Policy: Toward a Comprehensive Health Program for America's Military Personnel, Veterans, and Their Families
  9. The States' Role in National Health Reform
  10. Reducing Racial, Ethnic, and Socioeconomic Disparities in Health Care: Opportunities in National Health Reform
  11. Aging, Primary Care, and Self-Sufficiency: Health Care Workforce Challenges Ahead
  12. Building an Information Technology Infrastructure
  13. Should a Reformed System Be Prepared for Public Health Emergencies, and What Does that Mean Anyway?
  14. Nine Lessons for Health Reform: Or Will We Finally Learn from the Past?
  15. Health Care Reform: Lessons from the Past, Lessons for the Future
  16. Proving the Skeptics Wrong: Why Major Health Reform Can Happen Despite the Odds
  17. Introduction: Organ Donation and Death from Unexpected Circulatory Arrest: Engaging the Recommendations of the Institute of Medicine
  18. The Washington, D.C. Experience with Uncontrolled Donation after Circulatory Determination of Death: Promises and Pitfalls
  19. Legal Authority to Preserve Organs in Cases of Uncontrolled Cardiac Death: Preserving Family Choice
  20. Donation after Uncontrolled Cardiac Death (uDCD): A Review of the Debate from a European Perspective
  21. (Uncontrolled) Donation after Cardiac Determination of Death: A Note of Caution
  22. Organ Donation after Circulatory Determination of Death: Lessons and Unresolved Controversies
Independent Articles
  1. Preemption and the Obesity Epidemic: State and Local Menu Labeling Laws and the Nutrition Labeling and Education Act
  2. The Corporate Transformation of Medical Specialty Care: The Exemplary Case of Neonatology
  3. Neonatal Pain Relief and the Helsinki Declaration
  4. Brain Death Revisited: The Case for a National Standard
Columns
  1. Currents in Contemporary Ethics
  2. Teaching Health Law
  3. Reviews in Medical Ethics
  4. Recent Developments in Health Law
Table of Contents
Table of Contents
ASLME - [PDF] (Free Download)
Table of Contents
Letter From the Editor
Letter From The Editor
ASLME - [PDF]

On the Cusp: Insight and Perspectives on Health Reform
Symposium Articles
On the Cusp: Insight and Perspectives on Health Reform
Sara Rosenbaum, Jeanne M. Lambrew - [PDF]

Foreword: On the Cusp: Insight and Perspectives on Health Reform
America's Uninsured: The Statistics and Back Story
Diane Rowland, Adele Shartzer - [PDF]

This article provides an overview of why health insurance matters, a profile of the uninsured, and a discussion of the roles and limits of private and public health insurance as sources of coverage. It concludes with reflections on the current health insurance environment and prospects for reform.
Aiming High for the U.S. Health System: A Context for Health Reform
Karen Davis, Cathy Schoen, Katherine Shea, Christine Haran - [PDF]

Policy officials often assert that the U.S. has the best health care system in the world, but a recent scorecard on U.S. health system performance finds that the U.S. achieves a score of only 65 out of a possible 100 points on key indicators of performance in five key domains: healthy lives, access, quality, equity, and efficiency, where 100 represents the best achieved performance in other countries or within the U.S. The U.S. should aim higher by adopting a set of policies that will extend affordable health insurance to all; align financial incentives for health care providers to enhance value and achieve savings; organize the health care system around the patient to ensure that care is accessible and coordinated; meet and raise benchmarks for high-quality, efficient care; and ensure accountable national leadership and public-private collaboration. The incoming president and Congress should aspire to have the best health system in the world - not just assert it - and can do so by learning from examples of excellence within the U.S. and abroad.
Private Gain and Public Pain: Financing American Health Care
Bruce Siegel, Holly Mead, Robert Burke - [PDF]

Health care spending comprises about 16% of the total United States gross domestic product and continues to rise. This article examines patterns of health care spending and the factors underlying their proportional growth. We examine the "usual suspects" most frequently cited as drivers of health care costs and explain why these may not be as important as they seem. We suggest that the drive for technological advancement, coupled with the entrepreneurial nature of the health care industry, has produced inherently inequitable and unsustainable health care expenditure and growth patterns. Successful health reform will need to address these factors and their consequences.
Protect the Sick: Health Insurance Reform in One Easy Lesson
Deborah Stone - [PDF]

In thinking about how to expand insurance coverage, the issue that matters is whether insurance enables sick and high-risk people to get medical care. Over the course of three decades, market-oriented insurance reforms have shifted more costs of illness onto people who need and use medical care. By making the users of care pay for it (or even some of it), cost-sharing discourages sick people from getting care, even if they have insurance, and for people with low-incomes and tight budgets, cost-sharing can effectively deny them access to care. Thus, covering or not covering sick people is the core issue of health insurance reform, both as a determinant of support and opposition to proposals, and as the proper yardstick for evaluating reform ideas.
There's "Private" and Then There's "Private": ERISA, Its Impact, and Options for Reform
Phyllis C. Borzi - [PDF]

The Employee Retirement Income Security Act of 1974 (ERISA), a federal law regulating private employer-sponsored employee benefit plans, was primarily designed for pension plans, but has had a profound impact on state health care reform efforts. ERISA's broad preemption language has been judicially interpreted to preclude states from most forms of regulation of employer health plans, including benefit design (except through regulation of insurance products) and incorporating employer expenditure requirements in state health reform financing. But since 1974, Congress has never seriously returned to reexamine several fundamental questions: Should employers be required to offer or contribute to employee health coverage? Should ERISA preempt state efforts to take such actions? Or should ERISA incorporate more comprehensive regulation of health plans in these areas? Although the politics of ERISA preemption have thus far blocked federal reform, while allowing state reform activity to be simultaneously curtailed, new health reform efforts may force Congress to address these questions.
Why Public Programs Matter - and Will Continue to Matter - Even After Health Reform
Elizabeth J. Fowler, Timothy Stoltzfus Jost - [PDF]

Regardless of how health reform proceeds, we will continue to need public insurance programs to care for the poor, cover health problems not addressed by private insurance, and support the nation's health care infrastructure. This article examines that continuing role.
War, Its Aftermath, and U.S. Health Policy: Toward a Comprehensive Health Program for America's Military Personnel, Veterans, and Their Families
Michael J. Jackonis, Lawrence Deyton, William J. Hess - [PDF]

This essay discusses the challenges faced by veterans returning to society in light of the current organization and structure of the military, veterans, and overall U.S. health care systems. It also addresses the need for an integrated health care financing and delivery system to ensure a continuum of care for service members, veterans, dependents, and other family members. The health care systems of both the Department of Defense and the Department of Veterans Affairs execute their responsibilities to active duty service members, while their families and retirees/veterans are under separate legal authorities. Although they perform their mandates with extraordinary commitment and demonstrably high quality, both systems need to explore improved communication, coordination, and sharing, as well as increased collaboration with the Department of Health and Human Services programs serving the same populations, far beyond current efforts. The health care-related missions and the locus of health care delivery of each agency are admittedly unique, but their distinctions must not be permitted to impede system integration and coordination of a continuum of care provided to the men and women who serve the nation, and their families.
The States' Role in National Health Reform
Alan R. Weil, James R. Tallon, Jr. - [PDF]

The respective roles of states and the federal government in health reform is a defining feature of any proposal. Heterogeneity among states implies the need for different approaches in different places, but a possible consequence is variation in results and outcomes around the nation.
Reducing Racial, Ethnic, and Socioeconomic Disparities in Health Care: Opportunities in National Health Reform
Marsha Lillie-Blanton, Saqi Maleque, Wilhelmine Miller - [PDF]

Policy often focuses on reducing health care disparities through interventions at the patient and provider level. While unquestionably important, system-wide reforms to reduce uninsurance, improve geographic availability of services, increase workforce diversity, and promote clinical best practices are essential for progress in reducing disparities.
Aging, Primary Care, and Self-Sufficiency: Health Care Workforce Challenges Ahead
Fitzhugh Mullan, Seble Frehywot, Laura J. Jolley - [PDF]

A combination of "environmental factors" in the U.S. has led to an increased demand for health care professionals. However, there has been a significant decrease in the number of U.S. medical graduates selecting careers in family medicine and general internal medicine, thus driving demand for international medical graduates. At the heart of our national workforce policy needs to be good domestic and foreign policies, such as self-sufficiency approaches that include strategies to incentivize rural and underserved practice for U.S. medical graduates.
Building an Information Technology Infrastructure
Melissa M. Goldstein, David Blumenthal - [PDF]

The widespread adoption of health information technology (HIT) has been recognized as both a necessary element of health reform and a required building block of a modern, high performing health care system.
Should a Reformed System Be Prepared for Public Health Emergencies, and What Does that Mean Anyway?
Rebecca Katz, Jeffrey Levi - [PDF]

Any reformed health care system must be able to react to and mitigate the consequences of a public health emergency. This article identifies four essential components of public health emergency preparedness, and presents measures that can be taken immediately to improve our capacity to respond to emergencies
Nine Lessons for Health Reform: Or Will We Finally Learn from the Past?
James A. Morone, David Blumenthal - [PDF]

Health care reform sits, once again, in the eye of the political storm. This article, based on an analysis of past health care debates, offers nine historical lessons for contemporary reformers. We describe the most important political do's and don'ts.
Health Care Reform: Lessons from the Past, Lessons for the Future
Gail R. Wilensky - [PDF]

Health care reform is a perennial issue in elections - partly because of the challenges facing health care and especially because health care is an important issue for the swing voters. Making reform happen is harder. There are deep divisions within each of the parties not apparent during elections. Bipartisan support - and the willingness to accept the best legislation that can be passed as "good enough" - will be key.
Proving the Skeptics Wrong: Why Major Health Reform Can Happen Despite the Odds
Chris Jennings - [PDF]

Notwithstanding the pessimistic prognostications of Washington's cynical elite, broad health reform is achievable precisely because it is an economic and fiscal imperative. Indeed, the stakeholders with the greatest power to promote or undermine progress are on board, concluding that the status quo is unsustainable and the second best option is no longer to do nothing.
Introduction: Organ Donation and Death from Unexpected Circulatory Arrest: Engaging the Recommendations of the Institute of Medicine
James M. DuBois, Rebecca L. Volpe - [PDF]

Introduction: Organ Donation and Death from Unexpected Circulatory Arrest: Engaging the Recommendations of the Institute of Medicine
The Washington, D.C. Experience with Uncontrolled Donation after Circulatory Determination of Death: Promises and Pitfalls
Jimmy A. Light - [PDF]

The author recounts his experience with an uDCD program that ran for three years at the Washington Hospital Center in Washington, D.C. in the 1990s. Challenges, benefits, and lessons learned are considered in depth. A primary focus is the importance of community education, Organ Procurement Organization support, and the need for immediate in-situ preservation of organs.
Legal Authority to Preserve Organs in Cases of Uncontrolled Cardiac Death: Preserving Family Choice
Richard J. Bonnie, Stephanie Wright, Kelly K. Dineen - [PDF]

The gap between the number of organs available for transplant and the number of individuals who need transplanted organs continues to increase. At the same time, thousands of transplantable organs are needlessly overlooked every year for the single reason that they come from individuals who were declared dead according to cardiopulmonary criteria. Expanding the donor population to individuals who die uncontrolled cardiac deaths will reduce this disparity, but only if organ preservation efforts are utilized. Concern about potential legal liability for temporary preservation of organs pending a search for family members appears to be one of the impediments to wider use of donation in cases of uncontrolled cardiac death in states without statutes explicitly authorizing such action. However, we think that the risk of liability for organ preservation under these circumstances is de minimis, and that concerns about legal impediments to preservation should yield to the ethical imperative of undertaking it.
Donation after Uncontrolled Cardiac Death (uDCD): A Review of the Debate from a European Perspective
Pascal Borry, Walter Van Reusel, Leo Roels, Paul Schotsmans - [PDF]

Presumed consent alone will not solve the organ shortage, but it will create an ethical and legal context that supports organ donation, respects individuals who object to organ donation, relieves families from the burden of decision making, and can save lives.
(Uncontrolled) Donation after Cardiac Determination of Death: A Note of Caution
Christopher James Doig, David A. Zygun - [PDF]

In this short article, we articulate a position that organ recovery from uncontrolled DCD (uDCD) - primarily patients who have suffered a cardiac arrest - is unlikely to result in a significant number of organs, and this small gain must be balanced against significant risk of unduly influencing resuscitation provider decision-making, and jeopardizing public trust in the propriety of organ donation and transplantation.
Organ Donation after Circulatory Determination of Death: Lessons and Unresolved Controversies
James F. Childress - [PDF]

This article responds to the four pieces in this special symposium of the Journal of Law, Medicine & Ethics on uncontrolled organ donation following circulatory death (uDCD). The response will focus on lessons and debates about the kinds of consent necessary and sufficient for temporary organ preservation in the context of DCD and for organ donation itself; on conflicts of obligation, loyalty, and interest in DCD and ways to address those conflicts; and on benefit, cost, risk assessments of uDCD programs, including measures to achieve a more favorable balance of benefits, costs, and risks.
Independent Articles
Preemption and the Obesity Epidemic: State and Local Menu Labeling Laws and the Nutrition Labeling and Education Act
Lainie Rutkow, Jon S. Vernick, James G. Hodge, Jr., Stephen P. Teret - [PDF]

Obesity is widely recognized as a preventable cause of death and disease. Reducing obesity among adults and children has become a national health goal in the United States. As one approach to the obesity epidemic, public health practitioners and others have asserted the need to provide consumers with information about the foods they eat. Some state and local governments across the United States have introduced menu labeling bills and regulations that require restaurants to post information, such as calorie content, for foods offered on their menus or menu boards. A major dilemma is whether state and local menu labeling laws are preempted by the federal Nutrition Labeling and Education Act (NLEA). While few courts have addressed this issue, ongoing litigation in New York City provides an early glimpse of judicial interpretation in this area. This article explores these preemption issues, arguing that appropriately written and implemented menu labeling laws should not be preempted by the NLEA. We offer guidance for states and localities that wish to develop and implement menu labeling laws.
The Corporate Transformation of Medical Specialty Care: The Exemplary Case of Neonatology
Eleanor D. Kinney - [PDF]

The key to wealth in health care is the physician, who certifies to third-party payers that health care items and services are necessary for patient care. To compete more effectively for this wealth, physician specialists are organizing their practices into for-profit corporations and employing other physicians. Focusing on neonatology, this article describes the prevailing business model of these for-profit medical groups as controlling employed physicians through restrictive employment contract provisions, e.g., non-compete and mandatory arbitration clauses. With this business model and because of deficiencies in current law, for-profit medical groups eliminate competition from other physician specialists to the detriment of patients and consumers.
Neonatal Pain Relief and the Helsinki Declaration
Robert S. Van Howe, J. Steven Svoboda - [PDF]

The Helsinki Declaration is the universally accepted standard for ethical behavior in research involving human subjects. The Declaration calls for research studies to compare new therapies to the best current therapies. Despite this standard, multiple studies of pain relief interventions in newborns have recruited placebo controls instead of active controls using the best current therapy. These studies are evaluated using the standards required by the Helsinki Declaration, and the reasons for the ethical shortcomings of these studies are explored.
Brain Death Revisited: The Case for a National Standard
Eun-Kyoung Choi, Valita Fredland, Carla Zachodni, J. Eugene, Lammers, Patricia Bledsoe, Paul R. Helft - [PDF]

The concept of brain death - first defined decades ago - still presents medical, ethical, and legal challenges despite its widespread acceptance in clinical practice and in law. This article reviews the medicine, law, and ethics of brain death, including the current inconsistencies in brain death determinations, which a lack of standardized federal policy promotes, and argues that a standard brain death policy to be used by all hospitals in all states should be created.
Columns
Currents in Contemporary Ethics
Mark A. Rothstein - [PDF]

Currents in Contemporary Ethics
Teaching Health Law
Jennifer S. Bard - [PDF]

Teaching Health Law
Reviews in Medical Ethics
Frances H. Miller - [PDF]

Reviews in Medical Ethics
Recent Developments in Health Law
Sara Abiola and Inga Chernyak - [PDF]

Recent Developments in Health Law