Issue 5

Health Care Decisions in the New Era of Heath Care Reform: An Overview

By Joan H. Krause & Richard S. Saver

  Joan H. Krause** & Richard S. Saver*** “Some problems are so complex that you have to be highly intelligent and well informed just to be undecided about them.” – Laurence J. Peter, Peter’s Almanac.[1]  Peter’s wry observation, while not specifically about health care, aptly captures this symposium’s key themes. This symposium considers decision-making challenges in health care. The subject is timely, with the push to improve decision making as part of… READ MORE

92 N.C. L. Rev. 1445 (2014)

States’ Decision Not to Expand Medicaid

By Mark A. Hall

States’ Decisions Not to Expand Medicaid* Mark A. Hall** Introduction Is Medicaid Bad for Patients? How Much (if Anything) Will Medicaid Expansion Cost States? A. The Financial Costs and Benefits of Expansion B. Can Expanding States Back Out Later? Conclusion Introduction The Patient Protection and Affordable Care Act (“ACA”)[1]  presents states with two major decisions: (1) whether to create a state-based exchange for the purchase of subsidized private health insurance,[2]… READ MORE

92 N.C. L. Rev. 1459 (2014)

Health Care Spending and Financial Security After the Affordable Care Act

By Alison K. Hoffman

Click here for PDF *** Health insurance has fallen notoriously short of protecting Americans from financial insecurity caused by health care spending. The Patient Protection and Affordable Care Act (“ACA”) attempted to ameliorate this shortcoming by regulating health insurance. The ACA offers a new policy vision of how health insurance will (and perhaps should) serve to promote financial security in the face of health care spending. Yet, the ACA’s policy… READ MORE

92 N.C. L. Rev. 1481 (2014)

Prospects For Regulation of Off-Label Drug Promotion in An Era of Expanding Commercial Speech Protection

By Aaron S. Kesselheim & Michelle M. Mello

On December 3, 2012, the United States Court of Appeals for the Second Circuit handed the government yet another setback in its quest to stem the deleterious public health effects of aggressive pharmaceutical marketing. United States v. Caronia involved a First Amendment challenge to a pharmaceutical sales representative’s criminal misdemeanor prosecution for promoting the narcolepsy drug Xyrem for multiple off-label uses by making oral statements about uses of the drug not approved by the Food and Drug Administration… READ MORE

92 N.C. L. Rev. 1539 (2014)

Health Regulators as Data Stewards

By Kristin Madison

Click here for PDF Rapidly improving abilities to assemble and analyze massive datasets have the potential to transform health, healthcare, and the healthcare system. This article argues that in an era of big data, government regulators have the power to shape this transformation. One step that the federal government has taken to accelerate the transformation process is to make data bigger. By acting as a data generator, collector, aggregator, facilitator,… READ MORE

92 N.C. L. Rev. 1605 (2014)

Health Care Reform and Efforts to Encourage Healthy Choices by Individuals

By David Orentlicher

Health Care Reform and Efforts to Encourage Healthy Choices by Individuals* David Orentlicher** Introduction Background Menu Labeling Requirements III.     Employer Wellness Programs Conclusion Introduction While the Affordable Care Act (“ACA”)[1]  will do much to improve access to health care,[2] it may do far less to address other problems in health care and health, generally. For example, scholars have questioned whether the ACA will have a big enough impact… READ MORE

92 N.C. L. Rev. 1637 (2014)

Private Certifiers and Deputies in American Health Care

By Frank A. Pasquale

So-called “public programs” in U.S. health care pervasively contract with private entities. The contracting does not merely involve the purchase of drugs, devices, information technology, insurance, and medical care. Rather, government agencies are increasingly outsourcing decisions about the nature and standards for such goods and services to private entities. This Article will examine two models of outsourcing such decisions. In private licensure, firms offer a stamp of approval to certify that a given technology or service is up… READ MORE

92 N.C. L. Rev. 1661 (2014)

The End of End-of-Life Law

By Lois Shepherd

*** Introduction.. 1694 .. .. The Lay of the Land.. 1697 .. .. Even if You Do Everything Right, the Law Is Still a Problem.. 1705 A.………. The Pinettes………. 1705 B.………. The U.C. Book Club………. 1710 III. .. .. Why “End-of-Life” Decisions Should Be Treated Like Other Important Medical Decisions.. 1716 .. .. General Principles That Should Guide Law Relating to Health Care Decisions… 1719 A.………. Principle 1: Respect and… READ MORE

92 N.C. L. Rev. 1693 (2014)

Can Patients in the United States Become Savvy Health Care Consumers?

By Peter A. Ubel

Can Patients in the United States Become Savvy Health Care Consumers?* Peter A. Ubel** Introduction The Cost of U.S. Healthcare: A Brief and Broad History The Rising Burden of U.S. Healthcare Expenditures III. How “Skin in the Game” Ought to Work Lack of Price Transparency The Challenge of Getting Price Information in Time to Influence Healthcare Decisions.. 1766 A. Not Enough Time to Decide B. Unpredictable Trajectories of Care C. The… READ MORE

92 N.C. L. Rev. 1749 (2014)