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Distinguishing Moral Hazard from Access for High-Cost Healthcare under Insurance
Get PDFHealth policy has long been preoccupied with the problem that health insurance stimulates spending (“moral hazard”). However, much health spending is costly healthcare that uninsured individuals could not otherwise access. Field studies comparing those with more or less insurance cannot disaggregate moral hazard versus access. Moreover, studies of patients consuming routine low-dollar healthcare are not informative for the high-dollar healthcare that drives most of aggregate healthcare spending in the United States.We test indemnities as an alternative theory-driven counterfactual. Such conditional cash transfers would maintain an opportunity cost for patients, unlike standard insurance, but also guarantee access to the care. Since indemnities do not exist in U.S. healthcare, we fielded two blinded vignette-based survey experiments with 3,000 respondents, randomized to eight clinical vignettes and three insurance types. Our replication uses a population that is weighted to national demographics on three dimensions.We found that most or all of the spending due to insurance would occur even under an indemnity. The waste attributable to moral hazard is undetectable. We conclude that for high-cost care, policymakers should be more concerned about the foregone efficient spending for those lacking full insurance, rather than the wasteful spending that occurs with full insurance
How Law Libraries Can Help Tell the Black Lives Matter Movement’s Story
Get PDFIn Voices Across the Spectrum, our goal is to explore issues, perspectives, and resources that focus on promoting diversity, equality, anti-racism, LGBTQ rights, multicultural outreach and recruitment into the profession, inclusive workplaces, and more. While the first installments of this new column will focus on systemic racism issues, each column will examine different diversity and inclusion issues to help prompt conversations and break down silos within the profession
More than the Vote: 16-Year-Old Voting and the Risks of Legal Adulthood
Get PDFAdvocates of 16-year-old voting have not grappled with two significant risks to adolescents of their agenda. First, a right to vote entails a corresponding accessibility to campaigns. Campaign speech is highly protected, and 16-year-old voting invites more unfettered access to minors by commercial, government, and political interests than current law tolerates. Opening 16-year-olds to campaign access undermines a considered legal system of managing the potential exploitation of adolescents, which sometimes includes direct regulation of entities and also gives parents authority in both law and culture to prohibit, manage, or supervise contacts with every kind of person interested in communicating with their minor child through the age of 18. Second, voting is the most significant civil right. The history of other campaigns to earn the vote, including Woman’s Suffrage and 18-year-old voting, suggests that lowering the voting age will lead to a more far-reaching civil equality, meaning a lower age of majority, regardless of the current protestations of the Vote16 advocates. Lowering the voting age will therefore undermine the protective commitments we make to youth in school, in the justice system, and in the child welfare system. The neuropsychological development framework for evaluating 16-year-old voting needs to operate alongside a missing institutional analysis of the age of majority. Vote16 advocates cannot continue to avoid filling out the broader case for a 16-year-old age of majority and reckoning its inconsistency with current protective family and child welfare law. The Vote16 movement repeatedly justifies its case with evidence that lifelong voter turnout can be improved by starting younger. Conceding this point, this Article argues that lifelong voter turnout should not be improved at the cost of our ongoing commitment to a youth-protective legal posture. Because the agenda of Vote16 is to improve lifelong voter turnout rather than to address the status of adolescents, the movement has not grappled with situating its claim within the legal identity of adolescents broadly. Until Vote16 addresses these issues, state legislatures and local governments should pause their consideration of Vote16 proposals
Trafficking to the Rescue?
Get PDFSince before the dawn of the #MeToo Movement, civil litigators have been confronted with imperfect legal responses to gender-based harms. Some have sought to envision and develop innovative legal strategies. One new, increasingly successful tactic has been the deployment of federal anti-trafficking law in certain cases of domestic violence and sexual assault. In 2017, for example, victims of sexual assault filed federal civil suits under the Trafficking Victims Protection Reauthorization Act (“TVPRA”) against Hollywood producer Harvey Weinstein. Plaintiffs argued that the alleged sexual assault conduct amounted to “commercial sex acts” and sex trafficking. Other plaintiffs’ lawyers have similarly invoked trafficking law against a range of defendants, such as fundamentalist leader Warren Jeffs, Olympic Taekwondo coach Jean Lopez, and well-known photographer Bruce Weber. These efforts have largely succeeded, as federal district courts signal broader judicial acceptance of such federal trafficking claims.This Article traces federal human trafficking law from its origins to these recent innovative cases. It then considers how civil litigators are turning to human trafficking statutes to overcome decades-old systemic problems with legal responses to gender-based violence. The Article explores how the TVPRA offers unique, pragmatic advantages for plaintiffs. Yet, this trend involves risks, as the expanding deployment of trafficking statutes may lead to constitutional challenges, disproportionate criminal penalties, and confusion about the meaning of trafficking as a legal concept. This Article examines what these efforts signal about the future of human trafficking law as well as the field of gender-based violence
Core commitments for field trials of gene drive organisms
No full textGene drive organisms (GDOs), whose genomes have been genetically engineered to spread a desired allele through a population, have the potential to transform the way societies address a wide range of daunting public health and environmental challenges. The development, testing, and release of GDOs, however, are complex and often controversial. A key challenge is to clarify the appropriate roles of developers and others actively engaged in work with GDOs in decision-making processes, and, in particular, how to establish partnerships with relevant authorities and other stakeholders. Several members of the gene drive community previously proposed safeguards for laboratory experiments with GDOs (1) that, in the absence of national or international guidelines, were considered essential for responsible laboratory work to proceed. Now, with GDO development advancing in laboratories (2–5), we envision similar safeguards for the potential next step: ecologically and/or genetically confined field trials to further assess the performance of GDOs. A GDO\u27s propensity to spread necessitates well-developed criteria for field trials to assess its potential impacts (6). We, as a multidisciplinary group of GDO developers, ecologists, conservation biologists, and experts in social science, ethics, and policy, outline commitments below that we deem critical for responsible conduct of a field trial and to ensure that these technologies, if they are introduced, serve the public interest
New York Bail Reform: A Quick Guide to Common Questions and Concerns
Get PDFIn the wake of New York state passing comprehensive bail reform in 2019, legislators encountered fervent backlash. That backlash prompted several amendments, but many questions concerning the practical effects of the reforms remain. In this Essay, we explore the history of bail in New York, the amendments, and provide answers to some of the biggest questions and concerns surrounding bail reform in New York and elsewhere
Social, cultural and economic aspects of antimicrobial resistance
Get PDFAlthough often considered only a medical problem, antimicrobial resistance is an evolutionary challenge accelerated by social, cultural and economic factors that lead to the misuse, overuse and abuse of life-saving antimicrobial medicines. The antimicrobial resistance challenge is compounded by inadequate attention to disease prevention and response, global circulation of people and products, differences in industry and market regulations across countries, and a fragile pipeline of new antibiotics and their alternatives. While the discovery of new antimicrobials will provide temporary solutions, sustainable success requires rigorous social science research that explores the drivers of antimicrobial resistance. These solutions should promote balance between equitable access to, conservation of, and innovation for antimicrobials, adapted to local conditions across the globe
Who\u27s the Bigot?: Learning from Conflicts over Marriage and Civil Rights Law
No full textCharges, denials, and countercharges of bigotry are increasingly frequent in the United States. Bigotry is a fraught and contested term, evident from the rejoinder that calling out bigotry is political correctness. That is so even though renouncing—and denouncing—bigotry seems to be a shared political value with a long history. Identifying, responding to, and preventing bigotry have engaged the efforts of many people. People disagree, however, over who is a bigot and what makes a belief, attitude, or action bigoted. This book argues that bigotry has both a backward- and forward-looking dimension. We learn bigotry’s meaning by looking to the past, but bigotry also has an important forward-looking dimension. Past examples of bigotry on which there is consensus become the basis for prospective judgments about analogous forms of bigotry. The rhetoric of bigotry—how people use such words as “bigot,” “bigoted,” and “bigotry”—poses puzzles that urgently demand attention. Those include whether bigotry concerns the motivation for or the content of a belief or action; whether reasonableness is a defense to charges of bigotry; whether the bigot is a distinct type, or whether we are all a bit bigoted; and whether “bigotry” is the term society gives to beliefs that now are beyond the pale. This book addresses those puzzles by examining prior controversies over interfaith and interracial marriage and the recent controversy over same-sex marriage, as well as controversies over landmark civil rights law and more recent conflicts between religious liberty and state anti-discrimination laws protecting LGBTQ persons.https://scholarship.law.bu.edu/books/1240/thumbnail.jp
The Color Line: A Short Introduction
No full textThe Color Line provides a concise history of the role of race and ethnicity in the US, from the early colonial period to the present, to reveal the public policies and private actions that have enabled racial subordination and the actors who have fought against it.
Focusing on Native Americans, African Americans, Asian Americans, and Latino Americans, it explores how racial subordination developed in the region, how it has been resisted and opposed, and how it has been sustained through independence, the abolition of slavery, the civil rights movement, and subsequent reforms. The text also considers the position of European immigrants to the US, interrogates relevant moral issues, and identifies persistent problems of public policy, arguing that all four centuries of racial subordination are relevant to understanding contemporary America and some of its most urgent issues.
This book will be of interest to students and scholars of American history, the history of race and ethnicity, and other related courses in the humanities and social sciences.https://scholarship.law.bu.edu/books/1223/thumbnail.jp