Commonwealth Fund, via
NEJM
NEJM:
Hobby Lobby's outcome is of concern to U.S. health care professionals because our health insurance system is still largely dependent on employers. Employers and employees may have fundamentally different perspectives on which medical interventions are acceptable, particularly when the employer's fundamental mission is not to advance specific religious beliefs and its employees are therefore unlikely to be drawn exclusively from its own religious group. The Court's decision allows the beliefs of employers of various sizes and corporate forms to trump the beliefs and needs of their employees, potentially influencing the types of care that will be affordable and accessible to individuals and permitting employers to intrude on clinician–patient relationships.
The case also has important implications for efforts to achieve compromise between religious freedom and health care access. The Obama administration's attempts to compromise on the contraceptives-coverage mandate ultimately backfired, since its efforts were used to demonstrate that applying the mandate even to secular employers was not necessarily the only way to achieve the government's interests. In the future, regulators may be less willing to seek compromise lest their efforts be similarly used against them — and it is bad news for all of us if health policy can be made only through polarization and rancor rather than compromise. On the other hand, in other contraceptives-mandate cases working their way through the courts, nonprofit religious employers argue that the government's accommodations do not go far enough in protecting their religious freedom, essentially requiring them to deputize a third party to commit what they think is a sin on their behalf.
Finally, in the wake of Hobby Lobby, we may anticipate challenges to other medical services that some religions find objectionable, such as vaccinations, infertility treatments, blood transfusions, certain psychiatric treatments, and even hospice care. Hobby Lobby's implications may also extend into civil rights law, with employers asking to “opt out” of laws intended to protect people from employment and housing discrimination based on religion, race, sex, national origin, or pregnancy status. Although the majority deemed these slippery-slope concerns unrealistic, the dissent expressed serious concerns.
Though the decision applies only to closely held, for-profit corporations, it sets a precedent for religious exemptions that could have sweeping implications — and reflects the Supreme Court's great potential impact on U.S. health care. Yet the Court was applying Congress's statute, and Congress could, if it chose, scale back the protection offered to religious objectors — a good reason to share public reactions to the decision with our elected representatives.
More politics and policy below the fold.
NY Times:
The Obama administration, reeling from back-to-back blows from the Supreme Court this week, is weighing options that would provide contraceptive coverage to thousands of women who are about to lose it or never had it because of their employers’ religious objections.
The administration must move fast. Legal and health care experts expect a rush to court involving scores of employers seeking to take advantage of the two decisions, one involving Hobby Lobby Stores, which affects for-profit businesses, and the other on Wheaton College that concerns religiously affiliated nonprofit groups. About 100 cases are pending.
Jonathan Chait:
How Barack Obama Saved the Obama Administration
On most issues, Obama simply used his power the way any member of his party would have. On climate and health care, he bucked significant pockets of intra-party disagreement — not about policy goals themselves, which the whole Party shared, but of the prudence of accepting political risk to achieve them. And these two episodes where Obama’s own intervention proved decisive happen to be the two largest pieces of his domestic legacy.
Ron Brownstein:
Why Democrats Are So Confident
Republicans are trending against a growing cultural majority, while Democrats are in tune with it.
When we talk about much of conservative maneuvering, even the "wins", as rear-guard action. this is what we mean.
Zachary Goldfarb:
After making fighting income inequality an early focus of his second term, President Obama has largely abandoned talk of the subject this election year in a move that highlights the emerging debate within the Democratic Party over economic populism and its limits.
During the first half of this year, Obama shifted from income inequality to the more politically palatable theme of lifting the middle class, focusing on issues such as the minimum wage and the gender pay gap that are thought to resonate with a broader group of voters.
The pivot is striking for a president who identified inequality as one of his top concerns after his reelection, calling it “a fundamental threat to the American Dream, our way of life and what we stand for around the globe.”
The shift also underscores the ongoing dispute between the Democratic Party’s liberal and moderate wings over how to address inequality issues. Whereas the left takes a more combative tone, seeking to focus on the income gap and what it views as the harmful influence of big business and Wall Street, more centrist forces in the party favor an emphasis on less-divisive issues.
Dana Milbank:
As President Obama fails to get any credit for the millions who have found jobs or gained health-care coverage on his watch, a nonpartisan Quinnipiac poll this week found that 33 percent of Americans consider him to be the worst president since World War II, besting (or worsting, as it were) George W. Bush and leaving Jimmy Carter and Richard Nixon in the dust.
No wonder this bear wants to break loose. And maybe he will — if Republicans take control of the Senate.
Crazy talk, you say? Maybe so. The prevailing view is that a Republican Senate would only compound Obama’s woes by bottling up confirmations, doubling the number of investigations and chipping away at Obamacare and other legislative achievements.
Yet there’s a chance that having an all-Republican Congress would help Obama — and even some White House officials have wondered privately whether a unified Republican Congress would be better than the current environment. Republicans, without Harry Reid to blame, would own Congress — a body that inspires a high level of confidence in just 7 percent of Americans, according to a Gallup survey last month finding Congress at a new low and at the bottom of all institutions tested.
This is an idiotic idea. Appointments of all sort, including Justices, would be at risk. And don't ever buy into the idea that losing is good for its own sake. It never works out that way.
Marc Lipsitch:
Officials at the Centers for Disease Control and Prevention recently discovered that at least 75 workers there had been exposed to possible anthrax infection.
We should be glad that it was only anthrax. Anthrax is a dangerous but noncontagious bacterium; the risk to the exposed workers is real, but there is no danger of transmission to others. Much more troubling would be an accidental exposure to a dangerous, contagious pathogen.
And unfortunately, that’s also quite possible.
Experiments with contagious, virulent flu strains have been taking place in labs around the world, financially supported largely by the American, European and Asian governments, and more are planned. These experiments use flu strains like H5N1, which kills up to 60 percent of humans who catch it from birds.
Marc's a top-notch epidemiologist. More
here.