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The Point Washington Update - April 26, 2014

In this edition:

Article #1
Excerpted from www.tradeofinnocentsmovie.com: [CMDA member] Dr. Bill and Laurie Bolthouse have been passionately pursuing health care and justice issues for the past few years in such diverse places as Macedonia, Uzbekistan, Zimbabwe and India. This recent foray into film is their attempt to leverage their impact in championing the cause of victims of child sex trafficking. The story of Trade of Innocents, set in the seedy brothels of Cambodia, is close to their hearts as Bill and Laurie’s paths have intertwined with a few of these precious girls rescued from sex slavery and the brave men and women who labor tirelessly to help them. Their three teenage daughters Meredith, Madison and Molly actively participated with them on the set in Bangkok, Thailand. They reside in Littleton and Breckenridge, Colorado.

The story: In the back streets of a tourist town in present-day Southeast Asia, we find a filthy cinder block room; a bed with soiled sheets; a little girl waits for the next man to use her. Alex, a human trafficking investigator, plays the role of her next customer as he negotiates with the pimp for the use of the child. Claire, Alex’s wife, is caught up in the flow of her new life in Southeast Asia and her role as a volunteer in an aftercare shelter for rescued girls. Claire and Alex both still are dealing with their grief of losing a child years earlier. As both of them struggle in their own way to overcome the pain of their past and realities of child exploitation where they now live and work, they find themselves being pulled together into the lives of local neighborhood girls whose freedom and dignity are threatened. Parallel story lines intertwine and unfold twists against the backdrop of the dangerous human trafficking world, in a story of struggle, life, hope and redemption in the Trade of Innocents.


Commentary #1
CMA Vice President for Government Relations Jonathan Imbody: "I enjoyed the privilege of meeting with the Bolthouses during a two-day event that integrated a preview of their movie with a symposium on human trafficking. The symposium, held at Yale Law School, included an address by Lou CdeBaca, U.S. ambassador at large for anti-trafficking in persons, and a video greeting from Sec. of State Hillary Clinton. The Trade of Innocents movie is due out this Fall and will include CMDA among a resource list of organizations fighting human trafficking.

"CMA has worked with the U.S. Department of State, the Department of Homeland Security and the U.S. Department of Health and Human Services to develop and encourage efforts to educate health care professionals on how to recognize, report and treat victims of human trafficking. To that end, CMDA staff and members, led by Global Health Outreach director Dr. Don Thompson and CMDA member Dr. Jeff Barrows, have developed online curricula that carries AMA PRA Category 1 CreditTM and AGD PACE Credit.

"Data suggest that health care professionals can play a lifesaving role in identifying and reporting victims of human trafficking. Consider taking the time to begin our online course to equip yourself and others to save lives. And when Trade of Innocents comes to a theater near you this fall, take some friends and colleagues to see it.”


Article #2
Excerpted from "Warning: Contraceptive Drugs May Cause Political Headaches," by R. Alta Charo, J.D., N Engl J Med 2012; 366:1361-1364 (10.1056/NEJMp1202701) published on March 14, 2012, at NEJM.org.
Downloaded 4/23/123 at http://www.nejm.org/doi/full/10.1056/NEJMp1202701.

Most critics of the federal effort to ensure access to contraceptives have reframed the issue as a war on religion. Despite the administration's accommodations, the policy's opponents have reframed it as discrimination against religious organizations — even against religion itself.

There are at least two competing views about how to organize our public institutions, public places and public duties. In one vision, individuals may exercise their freedom to act on their religious dictates even if their acts limit access to public goods by people who follow a different creed.

The competing view is that people performing public functions must make themselves available to everyone, regardless of personal creed — for example, an airport taxi driver must pick up passengers carrying duty-free alcohol even if he or she deems drinking to be sinful.

Similar reasoning underlies many arguments for the acceptability of service denials: the patient should simply go elsewhere. But it is far from a solution when sectarian-hospital emergency departments refuse to provide emergency contraception to rape victims or to perform health-preserving surgeries after incomplete miscarriages. A vision of a public space in which every religious practice blooms might quickly become one in which a single religious doctrine is imposed.

Given the lack of past controversy over state laws on contraceptive insurance coverage and the spate of recent efforts to constrict reproductive rights — ranging from “personhood amendments” granting fertilized eggs the same legal rights as liveborn children, to mandatory transvaginal ultrasonography before consenting to an abortion, to the defunding of screening for cancer and sexually transmitted diseases at organizations that separately provide privately funded abortion services — some observers characterize the debate over contraceptive coverage as a war on women.

And the objections [by institutions opposing the new contraceptives policy] in this instance are yet more tenuous: Catholic hospitals and universities are not required to pay for birth-control coverage. Nonetheless, coverage in the general benefit package is considered unacceptable complicity. By this logic, any benefit that an employee might use to commit an act contrary to institutional doctrine could be withheld — including, it would seem, ordinary salary.

Let's recognize that the current debate is about public health and contraception. But at the same time, given the battle over framing, let's also take seriously the more enduring question about our public space: whether every religious institution and adherent is free to act to the point of imposing on others, or whether every individual is free from being imposed upon to the point of stifling some who would act. This debate deserves more than partisan sound bites and slogans.


Commentary #2
CMDA Member Mark McQuain, MD:
"Trust and the Elimination of Physician Conscience Rights"
"Dr. Nigel Cameron, in 'The New Medicine' asserted: “The only protection for the patient’s conscience in a situation of contested ethical values lies in a right to oversee the ethical options open to the physician.'"

"The issue was informed consent in the absence of ethical consensus at the heart of medical practice. Given loss of conscience protections for physicians in the U.S. Department of Health and Human Services (HHS) regulations and increased bureaucratic control of physicians by the Patient Protection and Affordable Care Act (PPACA) [often referred to as 'Obamacare'], it is unclear that the physician will bring anything to the future doctor-patient relationship other than a technical skill set.

"What little remaining ethical foundation allowed the physician may be insufficient for a trust relationship to develop between the physician and patient. If the physician can be forced to suppress her own concept of the best interest of the patient to the patient’s own, she can also be forced to subordinate it to any third party. Per Cameron, the patient’s conscience is surely protected from an ethically hamstrung physician, but it remains to be seen whether the patient or her conscience is protected from the larger ethical elephant in the exam room - the pluralistic, bureaucratic federal government."

CMDA's Family Practice Section President Beverly Nuckols, MD: "First Amendment on Life Support"
"Charo’s entire argument relies on readers’ agreement that the argument is about 'public policy and contraception.' It is vital to her argument because, if we understand that the issue relates to 'an establishment of religion,' Congress cannot legitimately pass, and the Executive Branch may not enforce, any law that violates the First Amendment.

"Charo’s essay is a political appeal, full of the 'partisan sound bites and slogans' she denounces, including the lie about mandatory transvaginal ultrasounds. The worst error of logic is her warning that religious institutions might withhold 'ordinary salary.' I don’t know of any religious organization that considers paying a salary sinful. Keeping a promise and honoring a contract like that in the First Amendment is sacred, a matter of conscience."


Article #3
Excerpted from "Restarting Health Care Reform: A New Agenda," by Nina Owcharenko, Director, Center for Health Policy Studies, the Heritage Foundation: "Lawmakers should also set in place an alternative that will permanently fix the broken parts of the health care sector. Unlike Obamacare, Congress should pursue an approach to health care reform that preserves the doctor-patient relationship and cutting-edge innovation while controlling costs and expanding access to private health coverage.

In sharp contrast to a centralized, government-based structure, the alternative is based on a patient-centered, market-based model. This new vision for health care reform would focus on personal ownership. Unlike today’s flawed third-party payment system, consumers would be in charge of their health care dollars and decisions. Health plans and providers would be directly accountable to patients—not a government official, a managed care executive or an employer.

There are four key steps to moving toward patient-centered, market-based health care reform.

  1. Make tax policy fair and rational. Congress should replace the current tax treatment of health insurance with a credit that is individually based.
  2. Start health care entitlement reform. As a first step, Congress could easily allow individuals facing retirement to keep their private health insurance into retirement and receive a defined contribution from the Medicare program.
  3. Promote choice and competition through insurance market reforms. Congress should focus on removing market barriers to interstate purchase of health insurance, addressing access issues for the hard-to-insure and making pooling arrangements more effective.
  4. State-based reforms. State policymakers should begin by assessing their own health insurance challenges related to insurance markets and their Medicaid programs.

Commentary #3
CMA Vice President for Government Relations Jonathan Imbody:
"My friend Nina Owcharenko outlines sensible innovations that promise the potential to begin to bend the curve of health care costs and shift decision-making back toward patients and physicians. Hopefully having learned its lessons from ramming through a massive health care law that only one party and less than half the country supported, Congress should come together to craft a pragmatic and measured approach to health care reform that doesn't involve taking over the world.

"Assuming the Court declares "Obamacare" unconstitutional, cooler heads in Congress can focus on those reforms most likely to garner enough bipartisan agreement for passage. Start by ramping up tracking and enforcement programs to cut Medicare fraud and waste. Provide compassionate, fiscally sustainable safety nets for the most needy, such as indigent patients and those caught in health care crises not covered by insurance. Tamp down costs by increasing competition and allowing patients to purchase insurance plans beyond state borders, as with car insurance. Stanch the hemorrhage of doctors from medicine by reasonably reforming malpractice lawsuits, slashing paperwork and bureaucratic meddling, and clarifying First Amendment conscience protections for health care professionals.

"The jacobinic health care revolution has failed. It is time now to reform health care democratically with careful, considerate compromise on the pragmatic principles that most Americans support."

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