Jacqueline Fox - Academia.edu (original) (raw)
Papers by Jacqueline Fox
Healthism can identify situations where a person is subject to a particular form of bigotry based... more Healthism can identify situations where a person is subject to a particular form of bigotry based on their individual health status. In health insurance, some forms of healthism are unavoidable due to the very nature of health insurance structures. However, when analyzing health insurance programs, particularly those that are funded through government, it is possible to utilize a healthism framework to, first, recognize and minimize and potentially ameliorate the worst effects of healthism combined with intersectionality. This Essay analyzes these issues as they relate to health insurance, Medicare, and the potential role of the Independent Payment Advisory Board
Jonathan Herring, in his book Caring and the Law, contends that the law does not properly recogni... more Jonathan Herring, in his book Caring and the Law, contends that the law does not properly recognize the importance of caring, and, instead, tends to isolate, disregard, or undermine both those who provide care and the relationships where caring occurs. Herring tackles this problem using the philosophical theory of the ethics of care to analyze the legal system.One of his overarching concerns is that, in both the United States and England, where the book was published, we tend to view both health law and bioethics through a lens that values autonomy above all.In this book, Herring takes on a formidable task, or, rather, a series of formidable tasks. In the first three chapters of this book, he defines the philosophical concept of the ethics of care, and he does so from the perspective of a lawyer, directly confronting highly fraught philosophical and legal issues that can arise within this ethical framework. The remaining six chapters endeavor to cover an extraordinary breadth of spe...
Political Economy: Government Expenditures & Related Policies eJournal, 2017
Zika is a mosquito-borne and sexually transmitted disease that is a dangerous threat to pregnant ... more Zika is a mosquito-borne and sexually transmitted disease that is a dangerous threat to pregnant women, causing catastrophic birth defects in a large percentage of fetuses when their mothers become infected while pregnant. It raises numerous issues related to abortion, birth control, poverty, and women’s control over their procreative choices. While the United States received ample warning from January 2016 onward that it was at risk of local transmission of this virus and public health officials at all levels generally behaved properly, the state and federal legislative responses in the summer of 2016 were entirely inadequate. For example, no state at a high level of risk undertook to provide long lasting and reliable birth control to all women who wanted it. Furthermore, Congress took a seven-week recess at the height of mosquito season without providing any funding for a Zika response. In light of these failures, it appears that the federalist system that allocates both public he...
Health & the Economy eJournal, 2014
The Independent Payment Advisory Board (IPAB) has been vilified as a “death panel.” Despite these... more The Independent Payment Advisory Board (IPAB) has been vilified as a “death panel.” Despite these and other criticisms, the IPAB statute can and should be interpreted to make health care better, safer, and less wasteful for the United States healthcare system by focusing payment towards newly developed medical treatments that are most effective. The United States healthcare system seems to be riddled with waste. Unnecessary care is a serious moral problem, causing unnecessary suffering, and waste is an equally serious moral problem, leading to an indefensible scarcity of resources available to care for those who need it. The current incentive structure pushes medical advances towards the broadest possible market for the most expensive drugs, devices and medical services, with little regard for defining the narrow populations most likely to benefit. IPAB has the potential to countervail these current incentives, driving medical care towards a far better system, costing less and carin...
Social Science Research Network, Apr 20, 2017
SSRN Electronic Journal, 2021
People are carrying tens of billions of dollars of medical debt, much of it in collections. We de... more People are carrying tens of billions of dollars of medical debt, much of it in collections. We delay going to the Emergency Department while having a heart attack because it may cost too much. Doctors try to help insured patients find the best coupon to offset the high copayment for a necessary prescription drug. For inexpensive drugs, insurers make a profit by clawing back copayments that exceed what the drug costs. People who are already arbitrarily disadvantaged because of race, gender, health status, LGBTQ status, obesity, etc. are disproportionately burdened by all of this. No one would design a system to end up this way. This article, through a series of case studies, does a close analysis of the healthcare insurance system from the perspective of people who use it, revealing a breathtakingly opaque, counter-intuitive, and burdensome muddle. The ACA did much good, as have subsequent reforms, but we can do better. I argue that we do not appropriately center the lived experience of people when we design and reform healthcare financing and show how doing so can ameliorate much of the harm that is currently occurring. Centering people does not pose an inherent conflict with conservative or liberal values. Bioethical principles such as autonomy, justice, integrity, and respect for dignity ought to be reflected in any plan. These principles can only be pursued by acknowledging how people truly experience systems they must interact with.
Seton Hall law review, 2008
In the early 1970s, Congress directed the Secretary of Health, Education and Welfare to create a ... more In the early 1970s, Congress directed the Secretary of Health, Education and Welfare to create a commission for the purpose of ascertaining the important principles that should guide biomedical research that uses human research subjects. The report of this commission was to be published by the Secretary in the Federal Register and, unless the Secretary made any other proposals, it was to become law, a statement of what the United States government required. This report became known as the Belmont Report, and its contents are widely known, 1 though its legal status is not as well-known or appreciated. The world of research and science has changed dramatically since the Belmont Report was written. This Article is not making a new claim when it says that pharmaceutical companies manipulate and suppress data that is generated on human research subjects in order to protect and expand on the industry's profitability. However, the interplay between this use of data and the requirements of the Belmont Report have, until now, gone unexamined. Last year literally millions of Americans were participants in medical research, with estimates ranging from 2.3 million to upwards
Healthcare reform is not a singular event but, instead, a constant process that will continue int... more Healthcare reform is not a singular event but, instead, a constant process that will continue into the foreseeable future. This Article proposes - for the first time - a creative solution to the acrimonious and debilitating method we currently use in assessing and implementing healthcare reform proposals. Current scholarship has not addressed the systemic problems that occur in the process of implementing healthcare reform, tending instead to focus on proposing singular reform measures to cure specific problems or on constitutional problems related to the Affordable Care Act. To address that gap, this Article carefully analyzes a case study of Medicare’s efforts to control unnecessary hospital admissions over the course of 30 years, efforts that have been subject to almost universal criticism, and uses this case study to illustrate perennial problems with reform more generally. The paper then explores other cultural and regulatory processes that function better than healthcare refor...
Medicare must decide whether to pay for extremely expensive new medical advances. This article sh... more Medicare must decide whether to pay for extremely expensive new medical advances. This article shows that Medicare does not have the legal power to consider cost when making these decisions, but does have a conflicting moral obligation to preserve scarce financial resources. Here, the legal, historical and political contexts that have led to this conflict are described and a proposal is made for fixing this by having Congress create independent boards to assess new technologies with an explicit mandate to consider cost.
University of Cincinnati Law Review, 2011
There is an extraordinary, distorting pressure that cost places on the healthcare system. While t... more There is an extraordinary, distorting pressure that cost places on the healthcare system. While the political system dictates the content of laws in this system, it is often the problem of cost that truly shapes how these laws are implemented. This article looks closely at this dynamic in the Medicare system, but also seeks to create a blueprint for further critical study of the broader problem’s effect on the institutions that health law seeks to regulate. In Medicare, CMS is not allowed to consider cost when making potentially expensive national coverage determinations about new medical technologies and procedures. Even with this constraint, it must grapple with both its own budget and the broader political problem of increased funding demands. This dynamic leads to hidden rationing of medical care for cost saving purposes. This article argues that broad scale rationing decisions such as these should be handled in a transparent manner, with ample opportunity for public input, whic...
HEN: Women's & Children's Health (Topic), 2011
Health care reform often involves a search for interventions that have the greatest value, both i... more Health care reform often involves a search for interventions that have the greatest value, both in terms of outcome and cost. Preventive dental care for children is simple, low risk, affordable, and has benefits that exceed its cost, making it a sensible type of care for all children to receive. However, there is a literal epidemic of preventable tooth decay amongst children in this country, an epidemic that has proven resistant to many attempts to ameliorate it. This epidemic leads to pain, poor school performance, poor nutrition, infection, and increased risk of heart problems in adulthood. It also, at times, leads to children’s deaths. This Article argues that this pervasive, stubborn problem of preventable dental decay is structural, and requires legal reforms to create a system whereby all, or at least most, children receive the necessary preventive care in a timely manner. This epidemic has highest rates of prevalence in children who have other significant stressors in their l...
The Journal of Law, Medicine & Ethics
... See also Edwin R. Render, The Privatization of A Military Installation: A Misapplication of T... more ... See also Edwin R. Render, The Privatization of A Military Installation: A Misapplication of The Base Closure and Realignment Act, 44 NAVAL L ... Medicare has been in the process of determining coverage criteria for a medical device called a left-ventricle assist device ("L-VAD"). ...
Health Care Cost Monitor, 2009
Health Care Cost Monitor, 2009
University of Cincinnati Law Review, 2010
pdf [hereinafter NHEP]. 4. Id. In 2008, healthcare expenditures were 16.2% of gross domestic prod... more pdf [hereinafter NHEP]. 4. Id. In 2008, healthcare expenditures were 16.2% of gross domestic products (GDP). Id. This 1.1% increase in percentage of GDP spent on health care is the greatest single year increase in U.
Yale journal of health policy, law, and ethics, 2011
Currently, fifty-three countries utilize dental therapists in programs modeled, at least in part,... more Currently, fifty-three countries utilize dental therapists in programs modeled, at least in part, on New Zealand's system. Id, 4. See Benjamin, supra note 2, at 158 (stating that carried and periodontal disease, left untreated, "may cause pain, dysfunction, poor appearance, loss of self-esteem, absence from school or work, and difficulty concentrating on daily tasks"). 5. Id. (calling dental carries and periodontal disease "largely preventable"). 6. Dental decay and cavities are the most common unmet medical needs of children.
Seton Hall law review, 2008
In the early 1970s, Congress directed the Secretary of Health, Education and Welfare to create a ... more In the early 1970s, Congress directed the Secretary of Health, Education and Welfare to create a commission for the purpose of ascertaining the important principles that should guide biomedical research that uses human research subjects. The report of this commission was to be published by the Secretary in the Federal Register and, unless the Secretary made any other proposals, it was to become law, a statement of what the United States government required. This report became known as the Belmont Report, and its contents are widely known, 1 though its legal status is not as well-known or appreciated. The world of research and science has changed dramatically since the Belmont Report was written. This Article is not making a new claim when it says that pharmaceutical companies manipulate and suppress data that is generated on human research subjects in order to protect and expand on the industry's profitability. However, the interplay between this use of data and the requirements of the Belmont Report have, until now, gone unexamined. Last year literally millions of Americans were participants in medical research, with estimates ranging from 2.3 million to upwards
International Journal of Healthcare Technology and Management, 2011
Healthism can identify situations where a person is subject to a particular form of bigotry based... more Healthism can identify situations where a person is subject to a particular form of bigotry based on their individual health status. In health insurance, some forms of healthism are unavoidable due to the very nature of health insurance structures. However, when analyzing health insurance programs, particularly those that are funded through government, it is possible to utilize a healthism framework to, first, recognize and minimize and potentially ameliorate the worst effects of healthism combined with intersectionality. This Essay analyzes these issues as they relate to health insurance, Medicare, and the potential role of the Independent Payment Advisory Board
Jonathan Herring, in his book Caring and the Law, contends that the law does not properly recogni... more Jonathan Herring, in his book Caring and the Law, contends that the law does not properly recognize the importance of caring, and, instead, tends to isolate, disregard, or undermine both those who provide care and the relationships where caring occurs. Herring tackles this problem using the philosophical theory of the ethics of care to analyze the legal system.One of his overarching concerns is that, in both the United States and England, where the book was published, we tend to view both health law and bioethics through a lens that values autonomy above all.In this book, Herring takes on a formidable task, or, rather, a series of formidable tasks. In the first three chapters of this book, he defines the philosophical concept of the ethics of care, and he does so from the perspective of a lawyer, directly confronting highly fraught philosophical and legal issues that can arise within this ethical framework. The remaining six chapters endeavor to cover an extraordinary breadth of spe...
Political Economy: Government Expenditures & Related Policies eJournal, 2017
Zika is a mosquito-borne and sexually transmitted disease that is a dangerous threat to pregnant ... more Zika is a mosquito-borne and sexually transmitted disease that is a dangerous threat to pregnant women, causing catastrophic birth defects in a large percentage of fetuses when their mothers become infected while pregnant. It raises numerous issues related to abortion, birth control, poverty, and women’s control over their procreative choices. While the United States received ample warning from January 2016 onward that it was at risk of local transmission of this virus and public health officials at all levels generally behaved properly, the state and federal legislative responses in the summer of 2016 were entirely inadequate. For example, no state at a high level of risk undertook to provide long lasting and reliable birth control to all women who wanted it. Furthermore, Congress took a seven-week recess at the height of mosquito season without providing any funding for a Zika response. In light of these failures, it appears that the federalist system that allocates both public he...
Health & the Economy eJournal, 2014
The Independent Payment Advisory Board (IPAB) has been vilified as a “death panel.” Despite these... more The Independent Payment Advisory Board (IPAB) has been vilified as a “death panel.” Despite these and other criticisms, the IPAB statute can and should be interpreted to make health care better, safer, and less wasteful for the United States healthcare system by focusing payment towards newly developed medical treatments that are most effective. The United States healthcare system seems to be riddled with waste. Unnecessary care is a serious moral problem, causing unnecessary suffering, and waste is an equally serious moral problem, leading to an indefensible scarcity of resources available to care for those who need it. The current incentive structure pushes medical advances towards the broadest possible market for the most expensive drugs, devices and medical services, with little regard for defining the narrow populations most likely to benefit. IPAB has the potential to countervail these current incentives, driving medical care towards a far better system, costing less and carin...
Social Science Research Network, Apr 20, 2017
SSRN Electronic Journal, 2021
People are carrying tens of billions of dollars of medical debt, much of it in collections. We de... more People are carrying tens of billions of dollars of medical debt, much of it in collections. We delay going to the Emergency Department while having a heart attack because it may cost too much. Doctors try to help insured patients find the best coupon to offset the high copayment for a necessary prescription drug. For inexpensive drugs, insurers make a profit by clawing back copayments that exceed what the drug costs. People who are already arbitrarily disadvantaged because of race, gender, health status, LGBTQ status, obesity, etc. are disproportionately burdened by all of this. No one would design a system to end up this way. This article, through a series of case studies, does a close analysis of the healthcare insurance system from the perspective of people who use it, revealing a breathtakingly opaque, counter-intuitive, and burdensome muddle. The ACA did much good, as have subsequent reforms, but we can do better. I argue that we do not appropriately center the lived experience of people when we design and reform healthcare financing and show how doing so can ameliorate much of the harm that is currently occurring. Centering people does not pose an inherent conflict with conservative or liberal values. Bioethical principles such as autonomy, justice, integrity, and respect for dignity ought to be reflected in any plan. These principles can only be pursued by acknowledging how people truly experience systems they must interact with.
Seton Hall law review, 2008
In the early 1970s, Congress directed the Secretary of Health, Education and Welfare to create a ... more In the early 1970s, Congress directed the Secretary of Health, Education and Welfare to create a commission for the purpose of ascertaining the important principles that should guide biomedical research that uses human research subjects. The report of this commission was to be published by the Secretary in the Federal Register and, unless the Secretary made any other proposals, it was to become law, a statement of what the United States government required. This report became known as the Belmont Report, and its contents are widely known, 1 though its legal status is not as well-known or appreciated. The world of research and science has changed dramatically since the Belmont Report was written. This Article is not making a new claim when it says that pharmaceutical companies manipulate and suppress data that is generated on human research subjects in order to protect and expand on the industry's profitability. However, the interplay between this use of data and the requirements of the Belmont Report have, until now, gone unexamined. Last year literally millions of Americans were participants in medical research, with estimates ranging from 2.3 million to upwards
Healthcare reform is not a singular event but, instead, a constant process that will continue int... more Healthcare reform is not a singular event but, instead, a constant process that will continue into the foreseeable future. This Article proposes - for the first time - a creative solution to the acrimonious and debilitating method we currently use in assessing and implementing healthcare reform proposals. Current scholarship has not addressed the systemic problems that occur in the process of implementing healthcare reform, tending instead to focus on proposing singular reform measures to cure specific problems or on constitutional problems related to the Affordable Care Act. To address that gap, this Article carefully analyzes a case study of Medicare’s efforts to control unnecessary hospital admissions over the course of 30 years, efforts that have been subject to almost universal criticism, and uses this case study to illustrate perennial problems with reform more generally. The paper then explores other cultural and regulatory processes that function better than healthcare refor...
Medicare must decide whether to pay for extremely expensive new medical advances. This article sh... more Medicare must decide whether to pay for extremely expensive new medical advances. This article shows that Medicare does not have the legal power to consider cost when making these decisions, but does have a conflicting moral obligation to preserve scarce financial resources. Here, the legal, historical and political contexts that have led to this conflict are described and a proposal is made for fixing this by having Congress create independent boards to assess new technologies with an explicit mandate to consider cost.
University of Cincinnati Law Review, 2011
There is an extraordinary, distorting pressure that cost places on the healthcare system. While t... more There is an extraordinary, distorting pressure that cost places on the healthcare system. While the political system dictates the content of laws in this system, it is often the problem of cost that truly shapes how these laws are implemented. This article looks closely at this dynamic in the Medicare system, but also seeks to create a blueprint for further critical study of the broader problem’s effect on the institutions that health law seeks to regulate. In Medicare, CMS is not allowed to consider cost when making potentially expensive national coverage determinations about new medical technologies and procedures. Even with this constraint, it must grapple with both its own budget and the broader political problem of increased funding demands. This dynamic leads to hidden rationing of medical care for cost saving purposes. This article argues that broad scale rationing decisions such as these should be handled in a transparent manner, with ample opportunity for public input, whic...
HEN: Women's & Children's Health (Topic), 2011
Health care reform often involves a search for interventions that have the greatest value, both i... more Health care reform often involves a search for interventions that have the greatest value, both in terms of outcome and cost. Preventive dental care for children is simple, low risk, affordable, and has benefits that exceed its cost, making it a sensible type of care for all children to receive. However, there is a literal epidemic of preventable tooth decay amongst children in this country, an epidemic that has proven resistant to many attempts to ameliorate it. This epidemic leads to pain, poor school performance, poor nutrition, infection, and increased risk of heart problems in adulthood. It also, at times, leads to children’s deaths. This Article argues that this pervasive, stubborn problem of preventable dental decay is structural, and requires legal reforms to create a system whereby all, or at least most, children receive the necessary preventive care in a timely manner. This epidemic has highest rates of prevalence in children who have other significant stressors in their l...
The Journal of Law, Medicine & Ethics
... See also Edwin R. Render, The Privatization of A Military Installation: A Misapplication of T... more ... See also Edwin R. Render, The Privatization of A Military Installation: A Misapplication of The Base Closure and Realignment Act, 44 NAVAL L ... Medicare has been in the process of determining coverage criteria for a medical device called a left-ventricle assist device ("L-VAD"). ...
Health Care Cost Monitor, 2009
Health Care Cost Monitor, 2009
University of Cincinnati Law Review, 2010
pdf [hereinafter NHEP]. 4. Id. In 2008, healthcare expenditures were 16.2% of gross domestic prod... more pdf [hereinafter NHEP]. 4. Id. In 2008, healthcare expenditures were 16.2% of gross domestic products (GDP). Id. This 1.1% increase in percentage of GDP spent on health care is the greatest single year increase in U.
Yale journal of health policy, law, and ethics, 2011
Currently, fifty-three countries utilize dental therapists in programs modeled, at least in part,... more Currently, fifty-three countries utilize dental therapists in programs modeled, at least in part, on New Zealand's system. Id, 4. See Benjamin, supra note 2, at 158 (stating that carried and periodontal disease, left untreated, "may cause pain, dysfunction, poor appearance, loss of self-esteem, absence from school or work, and difficulty concentrating on daily tasks"). 5. Id. (calling dental carries and periodontal disease "largely preventable"). 6. Dental decay and cavities are the most common unmet medical needs of children.
Seton Hall law review, 2008
In the early 1970s, Congress directed the Secretary of Health, Education and Welfare to create a ... more In the early 1970s, Congress directed the Secretary of Health, Education and Welfare to create a commission for the purpose of ascertaining the important principles that should guide biomedical research that uses human research subjects. The report of this commission was to be published by the Secretary in the Federal Register and, unless the Secretary made any other proposals, it was to become law, a statement of what the United States government required. This report became known as the Belmont Report, and its contents are widely known, 1 though its legal status is not as well-known or appreciated. The world of research and science has changed dramatically since the Belmont Report was written. This Article is not making a new claim when it says that pharmaceutical companies manipulate and suppress data that is generated on human research subjects in order to protect and expand on the industry's profitability. However, the interplay between this use of data and the requirements of the Belmont Report have, until now, gone unexamined. Last year literally millions of Americans were participants in medical research, with estimates ranging from 2.3 million to upwards
International Journal of Healthcare Technology and Management, 2011