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Context of 'April 17, 2006: Study Finds Health Care Companies Becoming Near-Monopolies'

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A study conducted by the American Medical Association (AMA) finds that health insurance companies are becoming near-monopolies. Ninety-five percent of the 294 HMO/PPO metropolitan markets surveyed have a Herfindahl-Hirschman Index (HHI) above 1,800. The HHI is used to determine whether a company’s control of the market warrants antitrust concern. A market with a rating of 1,800 is considered by the Department of Justice to be “highly concentrated.” Sixty-five percent of the companies surveyed have a rating over 3,000. The concentration is apparently the product of a period of intense consolidation within the industry. According to the AMA, there were more than 400 mergers during the preceding ten years. [American Medical Association, 2006 pdf file; Associated Press, 4/18/2006] “Patients do not appear to be benefiting from the consolidation of health insurance markets,” says AMA board member Dr. J. James Rohack. “Health insurers are posting historically high profit margins, yet patient health insurance premiums continue to rise without an expansion of benefits.” [Consumer Affairs, 4/18/2006] The AMA has asked the Department of Justice to take up antitrust action. But the organization says that in spite of the extremely high market concentration, regulators seem uninterested. [Associated Press, 4/18/2006]

Entity Tags: US Department of Justice, J. James Rohack, American Medical Association

Timeline Tags: US Health Care

The Department of Health and Human Services rescinds the controversial “conscience rule” that allows health care workers to refuse to provide abortion counseling or other family-planning services if doing so would violate their moral or religious beliefs. The rule was announced on December 19, 2008 as one of the Bush administration’s final policy initiatives. Seven states have already challenged the rule in court, arguing that it sacrifices the health of patients to religious beliefs of medical providers. The American College of Obstetrics and Gynecology has reported numerous cases regarding the rule, including a Virginia mother of two who became pregnant after being denied emergency contraception, and a rape victim whose prescription for emergency contraception was rejected by a pharmacist. Obama officials say the administration will consider drafting a new rule to clarify what health care workers can reasonably refuse for patients. The public has 30 days to respond to the move before it becomes viable. Sister Carol Keehan, president of the Catholic Health Association, said in December that her organization supported the rule because in recent years “we have seen a variety of efforts to force Catholic and other health care providers to perform or refer for abortions and sterilizations.” However, opponents of the rule, including the American Medical Association, the National Association of Chain Drug Stores, and Planned Parenthood, said it could have voided state laws requiring insurance plans to cover contraceptives and requiring hospitals to offer emergency contraception to rape victims. It could also allow drugstore employees to refuse to fill prescriptions for contraceptives. And the Civil Rights Act of 1964 already offers broad protection against discrimination based on religion, mandating that an employer must make reasonable accommodations for an employee’s practices and beliefs. Cecile Richards of Planned Parenthood says, “Today’s action by the Obama administration demonstrates that this president is not going to stand by and let women’s health be placed in jeopardy.” [Chicago Tribune, 2/27/2009; New York Times, 2/27/2009]

Entity Tags: Catholic Health Association, American Medical Association, American College of Obstetrics and Gynecology, Carol Keehan, US Department of Health and Human Services, National Association of Chain Drug Stores, Obama administration, Cecile Richards, Civil Rights Act of 1964, Bush administration (43), Planned Parenthood

Timeline Tags: US Health Care

Psychologists and medical ethicists react with horror to recent reports that a psychologist and various medical professionals took part in torturing prisoners—information that was revealed by recently released Justice Department memos (see April 16, 2009). A psychologist, whose name was redacted from the memos but is apparently James Mitchell (see January 2002 and After), provided, as the Washington Post reports, “ideas, practical advice, and even legal justification for interrogation methods that would break [detainee] Abu Zubaida, physically and mentally. Extreme sleep deprivation, waterboarding, the use of insects to provoke fear—all were deemed acceptable, in part because the psychologist said so.” The names of other psychologists and medical practicioners were also redacted from the memos. They monitored torture victims, helped keep them alive during sometimes-brutal interrogation sessions, and sometimes, the Post writes, “actively participated in designing the interrogation program and monitoring its implementation. Their presence also enabled the government to argue that the interrogations did not include torture.” The detainees were not the only ones being monitored. Psychologists were dispatched to each secret CIA prison, or “black site,” to make sure the medical professionals involved in the daily torture “could stand up, psychologically handle it,” says a former CIA official. Most of the psychologists were contract employees of the CIA.
Debate over Ethics of Participating in Torture - Frank Donaghue of the advocacy group Physicians for Human Rights says: “The health professionals involved in the CIA program broke the law and shame the bedrock ethical traditions of medicine and psychology. All psychologists and physicians found to be involved in the torture of detainees must lose their license and never be allowed to practice again.” George Annas, a professor of health law and bioethics, says, “I don’t think we had any idea doctors were involved to this extent, and it will shock most physicians.” The use of doctors to monitor torture victims is “totally unethical.… In terms of ethics, it’s not even a close call.” The American Medical Association’s policy guidelines state that physicians “must not be present when torture is used or threatened,” and doctors can treat detainees only “if doing so is in their best interest” and not merely to monitor their health “so that torture can begin or continue.” Author and professor of medicine Steven Miles says the actions described in the memos are the “kind of stuff that doctors have been tried, convicted, and imprisoned for in other countries—and that’s what should happen here.” But Michael Gross, an Israeli author and professor, says if medical professionals believe particular interrogation tactics do not constitute torture, then there is no reason for them not to participate. “Physicians are faced with a hard dilemma,” he says. “They have professional obligations to do no harm, but they also have a duty as a citizen to provide expertise to their government when the national security is at stake. In a national security crisis, I believe our duties as citizens take precedence.” The American Psychological Association (APA) has condemned any participation by its members in interrogations involving torture, but critics of the organization have noted that the APA has failed to censure members involved in harsh interrogations. The International Committee of the Red Cross said in a 2006 report, “The interrogation process is contrary to international law and the participation of health personnel in such a process is contrary to international standards of medical ethics.”
Memos Say US Doctors' Participation Morally Distinct from Instances in Other Countries - The memos acknowledged that the participation of medical professionals in torturing prisoners posed an ethical dilemma, but contended that the CIA’s use of doctors in such interrogations is morally distinct from the practices of other countries that practice torture. One such distinction was that doctors observing interrogations could stop them “if in their professional judgment the detainee may suffer severe physical or mental pain or suffering.” In one instance, the CIA chose not to subject a detainee to waterboarding due to a “medical contraindication,” according to a May 10, 2005, memo. [Washington Post, 4/18/2009]

Entity Tags: Frank Donaghue, American Medical Association, Abu Zubaida, Central Intelligence Agency, Washington Post, Michael Gross, Steven Miles, George Annas, International Committee of the Red Cross, US Department of Justice, American Psychological Association

Timeline Tags: Torture of US Captives

Betsy McCaughey, the former lieutenant governor of New York and a lobbyist for the health care industry, writes two frightening op-eds, one for the Wall Street Journal and one for the New York Post, that make false claims about the Democrats’ health care reform package. In the Journal, she claims that the bill contains a provision that would “pressure the elderly to end their lives prematurely,” a claim she has made before (see July 16, 2009). In the Post, she goes much farther, claiming that two of President Obama’s top health care advisers favor denying expensive health care treatments to senior citizens, the mentally disabled, and other “less productive” members of American society. She names Ezekiel Emanuel, a bioethicist, the health care adviser at the White House’s Office of Management and Budget (OMB), and a member of the Federal Council on Comparative Effectiveness Research. She cites a 2008 article by Emanuel in the American Medical Association’s journal, where he wrote that some doctors sometimes go too far, construing the Hippocratic Oath “as an imperative to do everything for the patient regardless of the cost or effects on others.” McCaughey takes Emanuel’s words and accuses him of wanting “doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else. Many doctors are horrified by this notion; they’ll tell you that a doctor’s job is to achieve social justice one patient at a time.” McCaughey states that Emanuel believes “medical care should be reserved for the non-disabled, not given to those ‘who are irreversibly prevented from being or becoming participating citizens…’ Translation: Don’t give much care to a grandmother with Parkinson’s or a child with cerebral palsy.” She also claims that Emanuel “explicitly” advocated denying health care to senior citizens in favor of providing treatment to younger patients. McCaughey claims that both Emanuel and Dr. David Blumenthal, the White House’s national coordinator of health information technology, favor “slowing medical innovation to control health spending” and denying patients access to advanced medical technology. According to McCaughey, Blumenthal also favors letting “computers tell… doctors what to do.” She concludes: “No one has leveled with the public about these dangerous views.… Do we want a ‘reform’ that empowers people like this to decide for us?” [Wall Street Journal, 7/23/2009; New York Post, 7/24/2009] A White House official later notes that McCaughey misrepresented Emanuel’s writings, and that Emanuel was describing positions and beliefs that he opposed in the same articles. ABC News’s Jake Tapper will note that Emanuel’s fellow doctors and medical ethicists know him as a fervent advocate of the rights of dying patients. [ABC News, 7/28/2009] And Emanuel himself will rebut McCaughey’s claims (see August 12, 2009). McCaughey’s previous claims about the dangers of health care reform, including her assertion that reform would encourage doctors to let senior citizens die, have been roundly debunked (see July 23, 2009).

Entity Tags: New York Post, Elizabeth (“Betsy”) McCaughey, David Blumenthal, Ezekiel Emanuel, Jake Tapper, Wall Street Journal, Federal Council on Comparative Effectiveness Research, Obama administration, Office of Management and Budget

Timeline Tags: US Health Care, Domestic Propaganda, 2010 Elections

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