Timothy Stoltzfus Jost

Health Care at Risk: A Critique of the Consumer-Driven Movement

In Health Care at Risk Timothy Stoltzfus Jost, a leading expert in health law, weighs in on consumer-driven health care (CDHC), which many policymakers and analysts are promoting as the answer to the severe access, cost, and quality problems afflicting the American health care system. The idea behind CDHC is simple: consumers should be encouraged to save for medical care with health savings accounts, rely on these accounts to cover routine medical expenses, and turn to insurance only to cover catastrophic medical events. Advocates of consumer-driven health care believe that if consumers are spending their own money on medical care, they will purchase only services with real value to them. Jost contends that supporters of CDHC rely on oversimplified ideas about health care, health care systems, economics, and human nature. In this concise, straightforward analysis, Jost challenges the historical and theoretical assumptions on which the consumer-driven health care movement is based and reexamines the empirical evidence that it claims as support. He traces the histories of both private health insurance in the United States and the CDHC movement. The idea animating the drive for consumer-driven health care is that the fundamental problem with the American health care system is what economists call “moral hazard,” the risk that consumers overuse services for which they do not bear the cost. Jost reveals moral hazard as an inadequate explanation of the complex problems plaguing the American health care system, and he points to troubling legal and ethical issues raised by CDHC. He describes how other countries have achieved universal access to high-quality health care at lower cost, without relying extensively on cost sharing, and he concludes with a proposal for how the United States might do the same, incorporating aspects of CDHC while recognizing its limitations.

A Comparative Study of the Law of Palliative Care and End‐of‐Life Treatment

This article examines the law of palliative care and end-of-life treatment in three common law countries, the United Kingdom, Australia, and Canada; and in five civil law countries, Poland, France, Germany, Japan and the Netherlands.

The Supreme Court and the Future of Medicaid

The Supreme Court ruled that the Medicaid expansion in the Affordable Care Act is unconstitutionally coercive toward the states. But which ACA Medicaid reforms are affected, how far the Courts new coercion doctrine goes, and how states will respond remain unclear.

Public Financing of Pain Management: Leaky Umbrellas and Ragged Safety Nets

Although many people in pain depend on public health care programs for aid, these programs cover pain relief only fragmentarily. He examines the gaps and deficiencies in Medicare and Medicaid funding of pain relief, and explores the effects of Medicare and Medicaid fraud enforcement on pain management.

Religious Freedom and Women's Health — The Litigation on Contraception

Under the Affordable Care Act, preventive services must be covered without patient cost sharing. Since guidelines were released in 2011 indicating that such services include FDA-approved contraceptive methods, 40 federal lawsuits have been filed challenging the policy.

Employers And The Exchanges Under The Small Business Health Options Program: Examining The Potential And The Pitfalls

The health insurance exchange is the centerpiece of the insurance reforms created by the Affordable Care Act. The Small Business Health Options Program (SHOP) is intended to create a marketplace for small, and perhaps eventually large, employers to purchase health insurance for their employees. This paper introduces a collection of articles that illuminate the need for small-business exchanges and discuss how they will function. The paper also describes the difficulties these exchanges will face, as well as the opportunities they will offer to states, employers, and individuals. The success or failure of small-business exchanges may well hinge on how states choose to address these challenges.

The Role of Competition in Health Care: A Western European Perspective

The Federal Trade Commission and Department of Justice 2004 report Improving Health Care: A Dose of Competition expresses a clear allegiance to competition as the organizing principle for health care. In Europe, by contrast, the key organizing principle of health care systems is solidarity. Solidarity means that all have access to health care based on medical needs, regardless of ability to pay. This is not to say that competition is not important in Europe, but competition must take place within the context of solidarity. This article critiques the report from a European perspective, describes the role of competition in Europe (focusing in particular on European Union law), and suggests that the United States could learn from the European perspective.

German Health Care Reform: The Next Steps

From the U.S. perspective, the German health care system offers much to be desired: universal access, moderate costs, and freedom of choice. The Germans consider their health care system to be in crisis, however, because the mechanisms on which they currently rely for financing and paying for health care, as well as the structures through which medical care is delivered, seem increasingly less viable. Germany has recently adopted modest reforms to partially address these problems. For longer term solutions, however, some in Germany are looking to U.S. managed care models, for better or for worse.

Implementing Health Reform: Four Years Later

Despite enormous potential, the Affordable Care Act has been plagued by controversy and confusion from day one.

Can the States Nullify Health Care Reform

869 The limitations of current safety-reporting mechanisms are well documented4,5 and have led the FDA to develop its recently announced Safe Use Initiative to reduce preventable harm from medicines. Patient self-reporting offers one solution that would enhance the capture of subjective elements of safety information. Given the clinical and scientific value of patient-reported adverse symptom events as well as the feasibility of collecting this information, one can make an ethical argument that patients are entitled to know the impressions of their peers — and that scientists, regulators, and clinicians should have access to those impressions when evaluating drugs. Such a change would lend all of us extra confidence when we reach into the medicine cabinet.