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Tag: SCOTUS

“What’s Up With The Alitos?”

By MIKE MAGEE

The 1st Presidential debate is just around the corner. What should be Jake and Dana’s 1st CNN question. Here’s a suggestion:

What’s up with the Alito’s these days?

Justice Sam weighed in with tipping the American scale (by virtue of his decisions) toward “godliness,” while a seemingly unhinged flag-flying Martha-Ann invited the world inside their marriage, declaring “He never controls me.” Good to know.

Making it clear that her visceral reaction to a neighbor’s PRIDE flag was faith-based, she revealed a short-fuse and a long memory. As she said, “I want a Sacred Heart of Jesus flag because I have to look across the lagoon at the pride flag for the next month. I said (to Sam), ‘When you are free of this nonsense, I’m putting it up.’”

Harvard sociologist, Robert Putnam, and his co-author, Notre-Dame political scientist David Campbell, made it clear in 2010 that something was up with gender, religion and politics in their publication, “American Grace: How Religion Divides and Unites Us.” In two sweeping surveys reported in the book, they revealed a change in attitudes that began to gain steam in 1970. To their surprise, “By 2006, majorities of every religious tradition except Mormons had come to favor women clergy. Nearly three-quarters of Americans said that women have too little influence in religion, a view that is widely shared across virtually all religious traditions and by both men and women.”

A recent AEI survey this year that catalogued religious affiliation of Boomers (1946-1964), Gen X (1965-1980), Millennials (1981-1996), and Gen Z (1997-2012) showed that women (in much greater numbers than men) apparently have had just about enough when it comes to religious subjugation. Only 14% of the baby boomer women were self-described religious “nones,” while 34% of Millennials and a whooping 39% of Gen Z’s were turning their backs on male-led religions.

The problem, experts say, tracks back to the concept of “complementarianism”, a belief that the Bible supports strictly different roles for men and women, and that “wives should submit to their husbands.”

Subjugation of women historically has taken many forms. The most recent has been the elimination of health care access with the Dobbs decision and reversal of Roe v. Wade. But placing a lid on women’s autonomy has a rich history in America. Take for example divorce.  It was outlawed in most states south of the Mason-Dixon line until the mid-19th century. As legal historian Lawrence Friedman explained, “Essentially husband and wife were one flesh; but the man was the owner of that flesh.”

In 1847, Wisconsin newspaperman and editor of the Racine Argus, Marshall Mason Strong, warned in an editorial that the “domestic sphere” was under attack with men being “degraded, the wife unsexed, and children uncared for.” Strong lamented the loss of women’s “finer sensibilities” with “every trait of loveliness blotted out.”

Two centuries later, the majority of women are having none of it, delivering political defeat after political defeat to religious conservatives after the Dobbs decision. That decision was the culmination of a carefully planned and executed conservative takeover of the Supreme Court with Justice Alito in the lead. His intent, according to Yale legal scholar Neil S. Siegel, was to protect “Americans who hold traditionalist conservative beliefs about speech, religion, guns, crime, race, gender, sexuality and the family. These Americans were previously majorities in the real or imagined past, but they increasingly find themselves in the minority.”

What do the Alito’s fear most? They fear that traditionalists like themselves will be “branded as bigots.” Justice Alito said as much in his dissent in Obergefell v. Hodges (same sex marriage). He wrote with some sense of drama “Those who cling to old beliefs will be able to whisper their thoughts in the recesses of their homes. If they repeat those views in public, they will risk being labeled as bigots and treated as such by governments, employers, and schools.”

His campaign to “protect majorities-turned-minorities” was also on full view five months before the 2016 Presidential election in his dissent after the Court declined to hear the case of a Washington State pharmacist who refused to fill prescribed contraceptives on religious grounds. Stormans, Inc. v. Wiesman, left standing according to Alito, was “likely to make a pharmacist unemployable if he or she objects on religious grounds to dispensing certain prescription medications…If this is a sign of how religious liberty claims will be treated in the years ahead, those who value religious freedom have cause for great concern.”

AEI has little encouragement to offer the Alito’s.

The survey’s conclusion is rather stark: “None of this is good news for America’s places of worship. Many of these young women are gone for good. Studies consistently show that people who leave religion rarely come back, even if they hold on to some of their formative beliefs and practices. The decline in religious participation and membership has provoked a good deal of concern and consternation, but these latest trends represent a four-alarm warning.

And therein lies the problem. The recent actions of the Alito’s simply dig the hole deeper, as they await a reckoning with demographic fate. For the Alito’s, “the moment has revealed the man (and the woman).”

Mike Magee MD is a Medical Historian and a regular THCB contributor. He is the author of CODE BLUE: Inside America’s Medical-Industrial Complex. (Grove/2020)

Are AI Clinical Protocols A Dobb-ist Trojan Horse?

By MIKE MAGEE

For most loyalist Americans at the turn of the 19th century, Justice John Marshall Harlan’s decision in Jacobson v. Massachusetts (1905). was a “slam dunk.” In it, he elected to force a reluctant Methodist minister in Massachusetts to undergo Smallpox vaccination during a regional epidemic or pay a fine.

Justice Harlan wrote at the time: “Real liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own, whether in respect of his person or his property, regardless of the injury that may be done to others.”

What could possibly go wrong here? Of course, citizens had not fully considered the “unintended consequences,” let alone the presence of President Wilson and others focused on “strengthening the American stock.”

This involved a two-prong attack on “the enemy without” and “the enemy within.”

The The Immigration Act of 1924, signed by President Calvin Coolidge, was the culmination of an attack on “the enemy without.” Quotas for immigration were set according to the 1890 Census which had the effect of advantaging the selective influx of Anglo-Saxons over Eastern Europeans and Italians. Asians (except Japanese and Filipinos) were banned.

As for “the enemy within,” rooters for the cause of weeding out “undesirable human traits” from the American populace had the firm support of premier academics from almost every elite university across the nation. This came in the form of new departments focused on advancing the “Eugenics Movement,” an excessively discriminatory, quasi-academic approach based on the work of Francis Galton, cousin of Charles Darwin.

Isolationists and Segregationists picked up the thread and ran with it focused on vulnerable members of the community labeled as paupers, mentally disabled, dwarfs, promiscuous or criminal.

In a strategy eerily reminiscent of that employed by Mississippi Pro-Life advocates in Dobbs v. Jackson Women’s Health Organization in 2021, Dr. Albert Priddy, activist director of the Virginia State Colony for Epileptics and Feebleminded, teamed up with radical Virginia state senator Aubrey Strode to hand pick and literally make a “federal case” out of a young institutionalized teen resident named Carrie Buck.

Their goal was to force the nation’s highest courts to sanction state sponsored mandated sterilization.

In a strange twist of fate, the Dobbs name was central to this case as well.

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It’s a Bird. It’s a Plane. No, It’s SCOTUS!!

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In a 6:3 decision, SCOTUS rescued Obamacare once again. Obamacare, untouched by Donald Trump and the Anti-Death Panelists, was almost brought to its knees by a single word; a lowly, miserable, reclusive preposition – “by”.

A brief summary.

Obamacare helps low income families buy health insurance through subsidies doled out by the Internal Revenue Service (IRS). Health insurance is sold at online marketplaces called exchanges. The online exchanges have been created by the state or the federal government. The statutes say that subsidies are available for insurance bought “through an exchange established by the state.”

The plaintiffs in King v. Burwell alleged that the IRS was illegally subsidizing people in over thirty states where the federal government, not the state, established the online exchanges.

The administration claimed that the subsidies applied in all states. That the language was admittedly sloppy and “by the state” also meant “by the federal government.” The country is now so polarized that even prepositions must take sides.

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King v. Burwell: Will the Supreme Court Save the Republican Party from Itself?

flying cadeuciiLast week, the Supreme Court heard arguments in the most recent and pernicious attack on the Affordable Care Act – aka Obamacare.  In the absence of a dysfunctional Congress, the case would be beneath the dignity of Court:  it addresses no complicated legal issues that might guide future decisions of lower courts.   Instead, the Supreme Court has been asked to decide whether a drafting error resulting in one unfortunate phrase in the much maligned 2000 page law –“Exchange established by the States” — means that more than 6.3 million citizens would not be eligible for federalsubsidies allowing them to afford commercial (i.e. – non-governmental) health insurance.

Ordinarily, Congress is expected to fix such drafting problems itself.  Each year Congress pass dozens of “Technical Corrections” bills to fix such errors in prior legislation.  These bills are akin to software patches that are regularly released by companies to fix unanticipated “bugs” previously release programs.  But this is no ordinary legislation.  Having spent six years vilifying for President Obama and has supporters for passing legislation that improves American lives it is far too late in the day for the Republican Congress to replace demagoguery with common sense.

So this issue is now in the lap of the Supreme Court, with its well-known partisan divide of four liberals, four arch-conservatives, and Justice Kennedy, who as the “swing vote” effectively decides many of the most divisive cases himself.  The Court can decide to gloss over this drafting error, as proposed by the Obama Administration, or apply its language to devastating effect.   Prior Supreme Court cases—i.e. “precedent” in the jargon of the law—can be found to support either position.   In the end, there have been few cases in which the Court has more judicial freedom – assuming precedent ever really binds the Court – to do whatever it wants in keeping with the Justices own political biases.Continue reading…

What’s wrong with Cannon, Halbig & King in 5 tweets

When the latest post from Michael Cannon–he who seeks to sink the subsidies attached to the Federal exchange–hit my inbox, I wondered, “Why don’t his opponents stop arguing the specifics, and instead explain what the Supreme Court ought to do. I also don’t see why Mark Andreeseen (@pmarca) should have all the fun with long Twitter essays. So in only 5 tweets complete with misspellings and other contortions to get my thoughts into 140 characters, this is what I sent back

King v Burwell: Three Scenarios

SCOTUS ROBERTS

By now, every reader of THCB must be aware the Supreme Court is hearing arguments this week in a case that could undermine much of Obamacare. Simplifying somewhat, the plaintiffs in King versus Burwell argue that the phrase “exchange established by the state” in the Affordable Care Act’s section 1311 dealing with tax subsidies precludes making such subsidies available to those who enroll through the federal exchange(s).  The government argues (a) that other sections of the law make it apparent that all exchange enrollees are potentially eligible for subsidies, and (b) that language in section 1321 providing that HHS shall “establish and operate such exchange within the state,” where a state is unable or unwilling to create their own exchange, essentially establishes a state exchange.

As many media articles have commented, the implications of a SCOTUS ruling for the plaintiffs are huge. Some five to eight million enrollees in the 34 federal exchange states would lose their subsidies, making insurance unaffordable for many of them, and premiums in these states would skyrocket—all while leaving the existing tax fines for being uninsured in place.

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What’s Changed Since the Obamacare Verdict

Ever since its controversial passage in 2010, the Affordable Care Act has been plastered with a range of polemic labels. Critics say Obamacare is job-killing; supporters herald it as life-saving.

Here’s another, perhaps unexpected label: personally profitable.

If you were among the true believers in the law a year ago today, there was easy money to be made. Nearly 80% of bettors on InTrade expected the law to be found unconstitutional; strategically spending about $25 in favor of the ACA could’ve netted you $800, based on how InTrade’s short-selling rules worked.

Much has changed, certainly, since Chief Justice John Roberts cast the deciding vote to uphold the law. (Beyond those bettors’ account balances, and the existence of InTrade itself, which mysteriously shut down in March.)

Here’s a look at how the Supreme Court’s decision on June 28, 2012, affected five hot-button issues related to the health law.

States’ decisions on Medicaid expansion

As of June 27, 2012: Several states with progressive governors and legislatures, like California, had moved to expand Medicaid ahead of the Supreme Court’s ruling. The Golden State’s leaders also had pledged to pursue universal coverage if the ACA was ruled unconstitutional.

But most states were waiting on the resolution of the constitutionality battle.

Since June 28, 2012: After the Court’s decision that the mandate was constitutional but that the Medicaid expansion was optional for states — which “took everyone by surprise,” said Matt Salo, executive director of the National Association of Medical Directors — governors were suddenly forced to decide whether the expansion made financial, and political, sense. Within a week, about ten states had signaled they’d expand Medicaid under the ACA.

However, many wary governors chose to wait for the November elections, and the knowledge of who would hold the White House, before announcing their plans; following President Obama’s reelection, a flurry of governors clarified their Medicaid stances throughout the winter and spring.

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Why Affirmative Action Still Matters in Medicine. And Probably Always Will…

I am an emergency room physician who has worked at Atlanta’s Grady Memorial Hospital for 17 years. I am also the first black woman to ever be hired as  a faculty member, and thus have had the opportunity  to teach students and doctors in training.  Given that 85% of the patients of the 120,000 patients that cross our threshold annually are black, my hiring carried enormous symbolic weight.

Beyond the symbolism, I’ve found a real effect on patient care. There are a few earlier studies which suggest that patients prefer doctors who look like them if given the opportunity.

Though we can’t yet confirm that physicians and patients of the same race improve health for minorities , we can still argue that increasing diversity in the healthcare professions is a worthy goal.  We must move to a place where physicians can comfortably care for people of all cultures and patients can feel comfortable being cared for physicians from different cultures.

In my own experience, African-American grandmothers, mothers, sisters, aunts all want to give me a hug when they see me walk in the room to treat them or their loved ones: “Go ahead sister,” they might say, “we’re so glad and proud to see you”.   I have also had many black patients tell me they were more comfortable talking with me about their history of abuse or addiction.  That kind of rapport leads to better care and a healthier population.

If the Supreme Court had ruled in favor of Abigail Fisher in Fisher vs. The University of Texas today, which they did not, opportunities for physicians of color who could establish that rapport might have been significantly diminished.

To eliminate or significantly weaken affirmative action, which would have been the result of a Fisher victory, would deal a significant blow to the ability of undergraduate programs to recruit and create a diverse student population—some of whom will continue on to medical school. To be sure, that blow would weaken medical schools nationwide.

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The Eight-Year Journey to Accountable Care

Now that the healthcare industry can work with clarity on care coordination strategies and programs, a new expansion of ACO models, trends in patient behavior and the companion issue of provider scope of practice have quickly emerged as critically-relevant spotlights. Historical perspective helps.

Simply put, even with the political tumult this fall, there is strong bipartisan support for aligning payment and care delivery models with improving quality to create a smarter and sustainable healthcare system, backed by historical precedent.

For me and my colleagues in the trenches of pursuing fiscally sound care delivery nearly a decade ago, it is well remembered that the origins of accountable care reside within a 2004 HHS document entitled “The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care.” This “Framework for Strategic Action” (as it is also known) was delivered to then-HHS Secretary and GOP-appointee Tommy Thompson. And it was delivered by the nation’s first National Coordinator for Health Information Technology, Dr. David Brailer.

The document’s goals of introducing health IT solutions to clinical practices, electronically connecting clinicians, using “information tools” to personalize care and advance population health reporting followed an executive order calling for widespread adoption of interoperable EHRs within 10 years.

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Ensuring the Long-Term Viability of Health Insurance Exchanges

November 16 marks the deadline for states to submit their plans for establishing a health insurance exchange—or HIX—either on their own or with some level of assistance from the federal government. For those states, a majority, according to Kaiser Family Foundation research, have yet to set up a HIX or develop concrete plans to do so. That’s an uncomfortably tight timeline in which to make some tough decisions.

According to the Supreme Court’s June ruling on the Affordable Care Act, states will no longer forfeit federal funding for Medicaid if they choose not to expand their Medicaid programs to all residents with incomes below 138 percent of the federal poverty level. Nevertheless, they must ensure coverage for an estimated 16 million currently uninsured people with an income between 100 percent and 400 percent of that poverty level. And by October 2013, each state needs to demonstrate that it has a HIX in place that can provide such cover: A user-friendly, one-stop shop for affordable healthcare, or affirmatively state that it intends to participate in the Federal exchange..

A HIX needs to have sufficient scale to support large and balanced risk pools. But there may not be sufficient numbers of uninsured state residents to make the HIX viable, particularly if a state is small, or has an extensive Medicaid program already in place. How will such states attract and sustain enrollment? How will they attract payers?

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