CRS memorandum on Bartlett antiabortion amendment.
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Deciding whether genetic differences among individuals are morally relevant to health insurance requires us to ask, What kind of good is health care? and, What principles should govern its distribution? There are good reasons to doubt that "actuarial fairness" is an adequate description of genuine fairness in health insurance.
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This article revisits a disconcerting phenomenon. The history of prominent 17th and 18th century moral theorists who exhibited disapproval of all forms of suicide is well known. Nevertheless, there are many bioethicists who continue to claim that either these moral theorists never actually opposed suicide, or that they never believed in the inalienable right to life and liberty that is an important basis for secular moral opposition to assisted suicide. These erroneous claims evince an improper historical methodology. They originate from the bioethicists' inaccurate quotation of the moral theorists and also from the bioethicists' unwillingness to understand the moral theorists in their relevant historical context. The author concludes that this attempt to obfuscate the true history of 17th and 18th century moral theory may also be removing a line of inquiry from originalist constitutional analysis that Federal Courts have a duty to engage in.
Hospice care, an appropriate way of caring for many terminally ill patients, now is reimbursed by Medicare and other insurance systems. However, access to hospice care is limited by unavailability, ignorance, Medicare regulations, and internally imposed restrictions. Reasons for the barriers to hospice care and other appropriate terminal care are discussed, together with potential actions that might improve care for dying patients.
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This article discusses the uninsured population and the phenomenon known as "patient dumping"--the transfer of a patient from one hospital (typically a private hospital) to a public hospital because of the patient's lack of insurance or inability to pay. The uninsured are the most vulnerable to patient dumping. The growth of patient dumping, a profile of the uninsured who are most likely to be a minority, and an analysis of federal and state policy responses to patient dumping are all discussed. The need for reform of the American health care system is highlighted and the Canadian health system is suggested as an alternative model.
Although medical care costs of the HIV epidemic by 1991 may reach $6 billion, or 1.2 percent of all estimated personal health care expenditures in the United States, costs per patient of treating AIDS appear to be declining. Calculating the epidemic's costs is difficult, however, in that data are lacking on health care expenditures for HIV-infected persons other than those with AIDS, intravenous drug users, women, and children. Shifts in demographic segments affected, changes in medical treatments, and diffusion beyond initial urban centers will alter the economics of AIDS. Prospective studies at both national and local levels are needed to gauge the epidemic's costs and demands on health services.
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BACKGROUND: In 1991, Medicare began covering screening mammograms subject to copayment and deductible. This study evaluated the effectiveness of Medicare in removing financial barriers to screening mammography among low-income older women. METHODS: In an inner-city public hospital's General Medicine Clinic, 119 consecutive, eligible, and consenting Medicare-enrolled women without known risk factors for breast cancer other than age, and no mammogram in the previous 2 years, were entered into a randomized controlled trial with follow-up after 2 months. The mean age was 71 years; 77% were black, 92% had an annual income below $10,000, and 52% had had a previous mammogram. All patients were counseled concerning indications for screening mammograms and Medicare coverage, and all were referred to a low-cost mammography facility. Sixty-one subjects were randomly assigned a voucher for a free screening mammogram at the referral facility. Obtaining a mammogram within 60 days of study entry was the main outcome measure. RESULTS: Of the women given vouchers, 27 (44%) obtained screening mammograms, compared with six (10%) of those without vouchers (P < .001). Adjustment by multiple logistic regression confirmed this association, yielding an adjusted odds ratio of 7.4 (95% confidence interval, 2.5 to 21.4). Knowledge concerning mammography and breast cancer increased significantly overall (and within randomization groups) between initial interview and follow-up; fear did not change. For women without the voucher, the main reason for not obtaining a mammogram was financial; the main reason for women with the voucher was transportation. CONCLUSION: In a low-income, inner-city population of older women, financial barriers to screening mammography persist despite Medicare coverage.