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“A Cardinal Reality Facing The Justices”: The Supreme Court Is Now A Death Panel

Back in March 2011, when the biggest threats facing Obamacare were the Supreme Court and the 2012 elections, I argued that the demise of the Affordable Care Act would put people’s lives in immediate danger.

At the time, the law had relatively few beneficiariespeople under 26 covered by their parents’ health plans, a small population of people with pre-existing medical conditions. But some of them had already used their new coverage to finance the kinds of life-saving treatments that would leave them in need of chronic care for the rest of their lives. Take away the health law, and most of these organ transplant recipients and other patients would have become unable to afford their medications, and some of them would die.

Since then, millions of people have gained coverage under the law, and that group of chronic care patients has grown much larger. But despite the fact that the Court upheld the law, and President Obama won reelection, the ACA isn’t out of danger.

On Friday, the Supreme Court agreed to hear a case that will determine whether the federal government can continue to subsidize private ACA coverage in states that didn’t set up their own insurance exchanges.

That case is King v. Burwell, but the issue at stake has come to be defined by a comparable case called Halbig v. Burwell.

The Fourth Circuit Court of Appeals ruled against the challengers in King, but the Supreme Court agreed to grant cert to those challengers anyhow, despite the absence of a Circuit Court split. If the five conservative Supreme Court justices are so inclined, they can void ACA subsidies for millions of beneficiaries, and cripple the insurance markets in about three dozen states.

Some of those beneficiaries will be the kinds of transplant recipients and other patients I wrote about three and a half years ago. Except today there are many more of them. Several of these patients explained the risk to their lives in an amicus brief, urging a different circuit court to reject the challenge to the subsidies, and thus to the viability of the insurance markets their lives depend on.

“Without insurance, Jennifer [Causor’s] treatments would be completely unaffordable. Her transplant cost nearly $280,000. She takes three anti-rejection drugs, one of which has a sticker price of $2,400 per month…. Should she become uninsured, Jennifer would face bankruptcy and even death.”

You can read the whole brief below. Conservatives are brimming with excitement over the Court’s decision to hear the challenge. Should the five conservatives rule that the text of the law doesn’t provide for federal subsidies in states that didn’t set up their own exchanges, they’ll place the onus on Congress or state governments to address the consequences for constituents who lose their benefits. The contested text could be fixed with a comically simple technical corrections bill, which Democrats would happily support. If Republicans were to sit on their hands, or use the ensuing chaos as leverage to extract unrelated concessions, it will cost people their lives. That is a cardinal reality facing justices, and the people soliciting their conservative activism.

There’s an ironic post-script to this article. The Supreme Court is likely to resolve this case with a 5-4 decision, one way or another. Either a single conservative will side with the Court’s four liberals as in 2012, and leave the law unscathed, or the five conservatives will align to void the subsidies.

Under the circumstances, supporters of the law might be nervous about the potential loss of a liberal justice. Ruth Bader Ginsburg’s health and advanced age make many liberals very uneasy, especially now that Obama’s ability to fill Supreme Court vacancies has come into doubt. But for the purposes of King, this issue is immaterial.

If Ginsburg’s seat were to become vacant, then the fate of the law would remain in the hands of a conservative swing justice. A 4-4 split effectively upholds the lower court’s rulingand since the Fourth Circuit upheld the subsidies, the subsidies would stand. If the Fourth Circuit had ruled the other way, her health would be much more material.

When I mentioned this admittedly morbid but nevertheless important curiosity on Twitter, a large number of dimwitted (or in some cases persistently dishonest) conservatives flooded my mentions column in outrage. Most of them missed the meaning altogether, and accused me of wishing death upon a conservative Supreme Court justice. But even the ones who didn’t managed to contain their enthusiasm over the possibility of millions of people losing insurance for a moment, to reprimand me for being so cavalier about people’s lives.


By: Brian Beutler, The New Republic, November 7, 2014

November 10, 2014 Posted by | Affordable Care Act, Obamacare, U. S. Supreme Court | , , , , , , , , | Leave a comment

“Blood Stained Hands”: America Safe For The Dick Cheneys But Not The Trayvon Martins

The heart just given to Dick Cheney…was Trayvon Martin’s. One is 71, the other 17.

What if that were literally true?

Let’s just say the metaphor tells a bitter truth: We are a nation safe for mean old white men in frail health. However, healthy black youths (most of all in the South) may be in peril with every breath and step they take out on the streets alone and unarmed. Just for living in black skin.

Apparently, wearing a hoodie further ratchets up the risk of being a black youth. The 17-year-old black slaying victim, Trayvon, was wearing one as he fell to the ground. “Hoodie protests” in New York, Philadelphia, Washington, and other cities in his memory have pointed to the loaded pack of prejudices associated with a simple sartorial style.

Oh, did I mention his fatal encounter was in a “gated community” (an oxymoron)? While they tend to be suspicious of dark teenage strangers, the message they send to all comers is “keep out,” not “come in.”

In the saddest story of 2012, a neighborhood watch “volunteer,” George Zimmerman, apparently concluded young Trayvon had no right nor reason to be walking the streets of Sanford, Fla., by himself with just a can of iced tea and some Skittles candy.

Zimmerman, an armed civilian, took the law into his own hands, reportedly starting a confrontation with Trayvon, even as he was told by a dispatcher to stop following the youth tagged as trouble. But it was Zimmerman who spelled trouble, in my reading of the facts. (No charges have been pressed against Zimmerman as of now.) Federal authorities are going to step in and investigate, thank goodness—a little late better than never.

In other words, if Zimmerman wasn’t looking for a fight, spoiling for one with his gun, this tragedy would not have come to pass. As it was, Trayvon knew he was facing serious danger and begged for his life—his very short life, I might add. All that he never got to see: “Gleams that untravelled world,” as the poet Lord Alfred Tennyson put it. It all ended with a bullet wound to the chest in February in Florida.

Florida bears blame for the outrage by having a vigilante justice system under a sitting Republican governor. The law they call “stand your ground” sanctions weapons of law enforcement to trigger-happy civilians like Zimmerman who have none of the training, scrutiny, code of conduct, or judgment of sworn police officers. Very nice, Florida, you’ve done it again. The year 2000 seems like yesterday.

I’ve seen law experts compare this case to the brutal murder of a 14-year-old Emmett Till in 1955, down South in the Mississippi Delta. Emmett, a black youth from Chicago, was a city boy visiting relatives that summer in a small town named Money. He didn’t know what he was up against in the strict code of conduct between whites and Negroes. Seen by some as a boy who stepped out of his place, he paid the ultimate price for it.

No question Till’s murder was a race-related hate crime in 1955, the year after Jim Crow laws were struck down by the Supreme Court. Yes, he was out of place, far from home when he lost his life for nothing.

But here’s the rub in 2012: Tall Trayvon was just a soon-to-be dead boy walking, on the way to becoming a young man. He got caught in racial crossfire on his own southern state’s home ground, not while visiting a strange land of hateful segregation. And yet he still got gunned down, in the eyes of multitudes, and for the color of his skin.

Meanwhile Cheney, doctors say, is doing “exceedingly well” in his white skin after a heart transplant. In his time, he’s been known to get aggressive in starting some scrapes, but they never left a mark on him. They are known as wars of choice in far-off lands. You can’t see the blood, but it’s on his hands.


By: Jamie Stiehm, U. S. News and World Report, March 27, 2012

March 28, 2012 Posted by | Civil Rights, Racism | , , , , , , , | Leave a comment

“Ethically Ironic”: How Was Dick Cheney Able To Get A Heart While Many Others Wait?

Dick Cheney has just joined a list of high-profile people, including Steve Jobs, Mickey Mantle, Evil Knievel and David Crosby who, received a transplant and thereby created a controversy. Cheney received a heart on Saturay from an anonymous donor at Inova Fairfax Hospital in Virginia after a 20-month wait. What is controversial about that? Cheney is 71 years old.

He has been through numerous previous operations that indicate he has other serious medical problems. He has only been able to survive due to the implantation of a left-ventricular assist device (LVAD) — a partial artificial heart — that has kept him going long past the point where his own heart could have kept him alive.

Nearly everyone on an LVAD winds up getting sicker and sicker and, eventually, so sick that they come off the transplant waiting list because the risk is too great.

What starts as a “bridge” to a transplant when you get an LVAD can become, the more time that passes, a final destination — you almost always die with the device. So despite his age and health problems, how was Cheney able to get a heart while many others wait?

It is concerning that a 71-year-old got a transplant. Many of those who manage to even make the waiting list for hearts die without getting one. More than 3,100 Americans are currently on the national waiting list for a heart transplant. Just over 2,300 heart transplants were performed last year, according to the United Network for Organ Sharing. And 330 people died while waiting.

According to UNOS, 332 people over age 65 received a heart transplant last year. The majority of transplants occur in 50- to 64-year-olds.

Most transplant teams, knowing that hearts are in huge demand, set an informal eligibility limit of 70.

Cheney is not the first person over 70 to get a heart transplant. He is, however, in a small group of people who have gotten one. Why did he?

Cheney has an advantage over others. It is not fame or his political prominence. It is money and top health insurance.

Heart transplants produce bills in the hundreds of thousands of dollars. The drugs needed to keep these transplants working cost tens of thousands of dollars every year. Organ donations are sought from the rich and poor alike. But, if you do not have health insurance you are far less likely to be able to get evaluated for a heart transplant much less actually get a transplant.

The timing of Cheney’s transplant is ethically ironic given that the battle over extending health insurance to all Americans reaches the Supreme Court this week.

If the President’s health reform bill is deemed unconstitutional, those who are wealthy or who can easily raise money will continue to have greater access to heart, liver and other forms of transplantation than the uninsured and underinsured.

It is possible that Cheney was the only person waiting for a heart who was a good match in terms of the donor’s size, blood type and other biological and geographical factors. If not, then some tough ethical questions need to be asked.

When all are asked to be organ donors, both rich and poor, shouldn’t each one of us have a fair shot at getting a heart? And in a system in which donor hearts are very scarce, shouldn’t the young, who are more likely to benefit both in terms of survival and years of life added, take precedence over the old?

Let’s hope we get some answers to these tough questions as we watch both Cheney’s recovery and the fate of health care legislation that is intended to minimize the advantages that the rich now have over the poor when it comes to proven life-saving treatments.


By: Art Kaplan, PhD, MSNBC Vitals; Contribution by MSNBC News Service, March 25, 2012

March 28, 2012 Posted by | Affordable Care Act, Health Care | , , , , , , , | 1 Comment


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