Zika and the Failure to Act Under the Police Power

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 health police powers and duties to act contains a flaw. The system creates a vacuum within which there are no enforcement mechanisms that can compel legislators to act appropriately. This Article analyzes the response from January through August 2016 from a legal, health policy, and ethical framework, concluding that a combined effort by courts and health policy experts is required so that the United States is better able to respond to early warnings about emerging infectious diseases in the future

The Lived Experience of Health Insurance: An Analysis and Proposal for Reform

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