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Health care is a right. Is someone preventing you from receiving or giving health care?
Start-up costs - In a survey by DesRoches et al. (2008), 66% of physicians without EHRs cited capital costs as a barrier to adoption, while 50% were uncertain about the investment. Around 56% of physicians without EHRs stated that financial incentives to purchase and/or use EHRs would facilitate adoption. In 2002, initial costs were estimated to be $50,000–70,000 per physician in a 3-physician practice. Since then, costs have decreased with increasing adoption. A 2011 survey estimated a cost of $32,000 per physician in a 5-physician practice during the first 60 days of implementation.
One case study by Miller et al. (2005) of 14 small primary-care practices found that the average practice paid for the initial and ongoing costs within 2.5 years. A 2003 cost-benefit analysis found that using EMRs for 5 years created a net benefit of $86,000 per provider.
Some physicians are skeptical of the positive claims and believe the data is skewed by vendors and others with a interest in EHR implementation.
Brigham and Women’s Hospital in Boston, Massachusetts, estimated it achieved net savings of $5 million to $10 million per year following installation of a computerized physician order entry system that reduced serious medication errors by 55 percent. Another large hospital generated about $8.6 million in annual savings by replacing paper medical charts with EHRs for outpatients and about $2.8 million annually by establishing electronic access to laboratory results and reports.
Maintenance costs - Maintenance costs can be high. Miller et al. found the average estimated maintenance cost was $8500 per FTE health-care provider per year.
Furthermore, software technology advances at a rapid pace. Most software systems require frequent updates, often at a significant ongoing cost. Some types of software and operating systems require full-scale re-implementation periodically, which disrupts not only the budget but also workflow. Costs for upgrades and associated regression testing can be particularly high where the applications are governed by FDA regulations (e.g. Clinical Laboratory systems). Physicians desire modular upgrades and ability to continually customize, without large-scale reimplementation.
Training costs - Training of employees to use an EHR system is costly, just as for training in the use of any other hospital system. New employees, permanent or temporary, will also require training as they are hired.
In the United States, a substantial majority of healthcare providers train at a VA facility sometime during their career. With the widespread adoption of the Veterans Health Information Systems and Technology Architecture (VistA) electronic health record system at all VA facilities, few recently-trained medical professionals will be inexperienced in electronic health record systems. Older practitioners who are less experienced in the use of electronic health record systems will retire over time.
HC is a right only if society generally agrees to that premise.
All so called "rights" in society depend on the society's willingness to enforce those rights.
At an international papal conference on health care yesterday at the Vatican, Pope Benedict XVI and other Catholic church leaders said it is the “moral responsibility of nations to guarantee access to health care for all of their citizens, regardless of social and economic status or their ability to pay.” Saying access to adequate medical care is one of the “inalienable rights” of man, the pope said, “Justice in health care should be a priority of governments and international institutions”
"So that's why the individual mandate's important," Obama explained in a speech on Aug. 15, 2011. "Because the basic theory is, look, everybody here at some point or another is going to need medical care, and you can't be a free-rider on everybody else," said Obama. "You can't not have health insurance, then go to the emergency room, and each of us, who've don the responsible thing and have health insurance, suddenly we now have to pay the premiums for you. That's not fair. So, if you can afford it, you should get health insurance just like you get car insurance."
However, in the Supreme Court on Monday, Justice Samuel Alito forced President Barack Obama’s solicitor general, Donald Verrilli, to admit that under Obamacare these free riders will not be eliminated despite the individual mandate. For an elite group—including people eligible for Medicaid who don’t sign up for it and people whose health care expenses exceed 8 percent of their income—the Obamacare mandate is no mandate and the penalty is neither a penalty nor a tax because they are not required to pay it, period.
Under Obamacare, Verrilli conceded, these people can continue to receive free health care care, not sign up for health insurance, not sign up for Medicaid, and not pay a penalty.
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The Family Research Council filed the amicus curiae in the case challenging the constitutionality of the individual mandate of the Patient Protection and Affordable Care Act, commonly known as Obamacare. The individual mandate is one provision in a larger law that also requires certain employers to provide government-approved insurance or face a penalty, establishes exchanges for government-approved insurance plans and requires insurers to cover pre-existing conditions. Key to the high court’s decision will be whether striking down this provision would nullify the entire law. The legislation did not contain a severability clause. Severability would allow some parts of the law to be struck down while maintaining others.
Opponents argue that that the provisiom requiring individuals to buy health insurance is not constitutional, while the Obama administration contends that the Commerce Clause of the Constitution allows it. Several lawsuits have been brought against the law, with some lower federal courts striking down the law and others affirming it. Other members of Congress to join the brief are House Judiciary Subcommittee on the Constitution Chairman Trent Franks (R-Ariz.), Republican Study Committee Chairman Rep. Jim Jordan (R-Ohio), Rep. Mike Pence (R-Ind.), a candidate for governor of Indiana and senior House Judiciary members Rep. Louie Gohmert (R-Texas) and Rep. Steve King (R-Iowa).
Ken Klukowski, legal counsel for the Family Research Council, and Nelson Lund, a professor at George Mason University School of Law, co-authored the brief. The FRC’s earlier brief was cited in Florida U.S. District Judge Roger Vinson’s decision to strike down the entire Obamacare law as unconstitutional. “After almost two years of impassioned debate, Obamacare will finally have its day before the Supreme Court,” Klukowski said in a statement. “The 'individual mandate' in Obamacare that requires all Americans to have health insurance is unconstitutional. And for the reasons we explain in this brief, 135 years of Supreme Court precedent show that this is one of those rare instances where striking down the individual-mandate provision requires the Court to strike down this entire 2,700-page law. “We have high hopes that the Supreme Court will recognize that the individual mandate is unconstitutional, and will act to safeguard the freedoms of all Americans by holding the individual mandate 'nonseverable,' and strike down every part of Obamacare,” Klukowski continued.
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would you willing to sign a waiver that would let hospitals deny you services if you didnt have insurance and could not pre-pay for them?Just because health care is important to your existence does not make it a human right. In the absence of someone to provide it for you, it's not something that you would have (if you were unable to provide it for yourself).
Declaring it as a right in the sense that many of you are is declaring that someone is compelled to provide it to you. As Texanmike says, compelling people in this manner is the same as slavery, you're simply talking about degrees of subjugation. Since healthcare isn't something everyone can automatically provide for themselves, we're simply talking opinions. While we're on opinions, it's mine that it isn't anybody's right, no matter how in need they are, to subjugate anyone else.
if health care isnt a right, then shouldnt this law be struck down? if health care is truly a service that one can choose to purchase or not, then hospitals should be able to deny services to those who can not pay.Citizens can't be denied treatment due to the Emergency Medical Treatment and Active Labor Act (EMTALA) generally referred to as the "Patient Anti-Dumping Act" that was signed into law by President Reagan.
A boisterous octet of Supreme Court justices, plus one silent partner, saw to that during a three-day, 6 ½-hour debate with lawyers defending and attacking what once was seen as Obama's proudest legacy. By the time it was over Wednesday afternoon, virtually everyone following the three-year battle within the three branches of the federal government had a strong opinion on the Patient Protection and Affordable Care Act. Everyone, that is, except for a few justices who hold its fate in their hands.
Those justices — particularly, it seems, Chief Justice John Roberts and Associate Justice Anthony Kennedy — know their decision in June will reverberate through the halls of Congress, the Oval Office in the White House, the examining rooms of doctors' offices and the classrooms of ivy-covered law schools for decades to come. Apart from their decision's effect on the health care law, the justices could be writing new chapters in the case law books on the concept of federalism, the economic powers of Congress and the government's relationship with its citizens. "What's at stake here is the basic nature of our government," said Paul Clement, the former solicitor general under President George W. Bush, who jousted with the justices all Tuesday and Wednesday.
To be sure, three days of feisty court debate didn't doom the health care law. Three justices, including the ever-silent Justice Clarence Thomas, appear likely to oppose the law. But with Kennedy and, to a lesser extent, Roberts straddling the middle ground in their questioning of lawyers for the government, 26 states and a consortium of small businesses, it remains possible the entire statute will be upheld. But it sure didn't sound that way beneath the mahogany courtroom's 44-foot ceiling.
On Monday, the justices eagerly elbowed aside an argument that they should delay the case until 2015 because of a tax law passed 145 years ago. "Ousters of jurisdiction are narrowly construed," Justice Antonin Scalia said. "Unless it's clear, courts are not deprived of jurisdiction." On Tuesday, the conservative justices pounced on U.S. Solicitor General Donald Verrilli's initially halting defense of the law's heart — its mandate that most Americans buy insurance or pay a penalty that might or might not be a tax, depending on the day of the week.
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A lawyer for 26 states challenging the law said the rest of the bill was untenable if the legal requirement to buy health insurance was struck down. The justices have heard three days of argument on the Affordable Care Act, the longest such debate in years. A decision could come in June, midway through the presidential campaign.
On Wednesday the law's challengers told the court that, without the so-called individual mandate, the law could not function in the way Congress intended and thus the whole bill must be scrapped. "If the individual mandate is unconstitutional then the rest of the act cannot stand," said Paul Clement, the lawyer representing the opposition.
The government argued that if the insurance mandate was quashed, two other provisions that depend on the mandate would have to go too - but most other elements of the 2,400-page law should remain. The two related provisions are a requirement to offer coverage to people with pre-existing medical conditions, and limits on how much insurance companies can charge in premiums based on a person's age or health. The Supreme Court has released audio recordings and written transcripts of Wednesday's proceedings.
A step beyond?
Some justices appeared to question whether it would be possible to redeem the bill if its core provision was struck down. Justice Antonin Scalia, a conservative who on Tuesday questioned the legality of the individual mandate, said: "My approach would be to say that if you take the heart out of this statute, the statute's gone." But Justice Elena Kagan - appointed to the court by President Obama - said that healthcare systems without a mandate operated well in states like Utah. "Is half a loaf better than no loaf?" she asked.
More http://www.bbc.co.uk/news/world-us-canada-17540133
