Ius Gentium

University of Baltimore School of Law's Center for International and Comparative Law Fellows discuss international and comparative legal issues


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Universal Health Care vs. Research – Why the United States Must Prioritize the Latter

Jasen Lau

Universal health care is a hot topic in America. Many other countries have already implemented universal health care, and to many, America seems backwards, late, and uncaring of its citizens. The truth is that America is not uncaring, but rather, America has its focus elsewhere. America, unlike many other countries, focuses on research, development, and advancement of medical technology and pharmaceutics instead of public welfare. Now, that isn’t to say that America is uncaring. America still has state medical assistance for those below the poverty line, Medicare for the elderly, and child health insurance programs for children whose families are above the poverty line yet are too poor to purchase private insurance, but the American healthcare system is designed to ultimately pay manufacturers and research institutes, not go back into the public. America currently leads the world in medical technology and pharmaceutics, producing more than half the world’s medications[1]. The American healthcare system rewards and incentivizes research instead of the public welfare of one nation because the goal of the US is to advance medicine as a whole, not just improve one nation.

Stethoscope World

With the advent of the Affordable Care Act (ACA), many people in the US now have healthcare. However, the ACA only required the purchase of insurance[2]. The ACA is not universal healthcare. Quite to the contrary, the ACA pushes more money goes into a system of healthcare professionals that ultimately fuel research. Patients pay premiums to pay for insurance companies; the insurance companies pay providers; those providers then have money to purchase medical equipment, pharmaceuticals, or other healthcare assets; those purchases further fund the institutes that directly advance the research for better medical technology; and they get their money from selling those technologies and advancements to providers. This unending cycle does not exist within many other countries.

Other nations, like England, Germany, Japan, Korea, Australia, and many, many others, have a ministry of health which directly provides healthcare to its citizens. For example, England follows a health constitution, the National Health Service Constitution for England (NHSC), to regulate how health care is covered. The system promises that no one will be denied care and that all health care is free[3]. On the surface, this sounds like what many people in the US want. However, the NHSC limits when the care may be provided. Directly on their main page, the NHSC suggests that vaccinations for the Shingles disease be given to people age 70 and up[4]. However, the Center for Disease Control (CDC) in the US recommend the vaccination as early as 60 years of age. Even the European Medicines Agency recognizes that the Shingles vaccine is meant for people as early as 50[5]. Therefore, how significant is a difference of 10 years? According to both England and the US, Shingles can often lead to pain – ranging from mild to moderate and described as sharp and stabbing pain[6]. In fact, the pain from Shingles is so debilitating that it is cited as the number two reason for suicide in elderly adults[7]. Further, 15 of 100 elderly people who suffer from shingles may become blind[8]. Most universal healthcare nations, however, cannot afford the vaccine on a nationwide scale that early. The point of determining when healthcare is allowed is to stagger the payments. It’s better to have 10 separate payments made instead of one massive lump sum. However, in the US, providers and hospitals are not state employees that must rely on taxpayer money to buy vaccines from drug manufacturers or machines from medical technology companies.

shingles-button-lg

In many countries where there is public universal healthcare, the vast majority of providers are state employees. Taking everything into account, nations like England have one insurance, one large organ of healthcare providers, and therefore one major purchaser of healthcare technologies and pharmaceuticals. With one entity fueling the money in a system, the layman would believe that money would be better controlled, and to a certain extent, that is correct.

Insurance companies negotiate reimbursement rates for providers[9]. So, the standard $100 rate for cash paying patients may be less for certain insurances where the doctor only gets $70, as an example. With a promise of lowered rates, though, insurance companies boasts their number of subscribers. So, the tradeoff is a lowered rate for the prospect of an increased number of patients and payment security. In America, where there are many insurance companies, providers are often given a wide selection with whom to contract and power to negotiate rates. However, in nations such as England, providers are employees of the State. The government need only compensate the provider at an agreed salary rate, and all the money for providers and research comes from taxes. These same taxes, therefore, are also used to purchase MRI machines, purchasing pharmaceutics, and developing whatever research is possible with the miniscule amount of money remaining. So, the entire financial burden of setting up hospitals, paying for providers, and buying medical equipment fall upon one single entity that controls nearly the entire healthcare system, and this can have grave consequences.

medical-research

No other country in the world rivals the US in availability of medical testing. MRI machines, for example, are more readily available in the US than any other country. For example, the US has more than 11,000 MRI machines, around 35 machines per 1,000,000 inhabitants. The second highest country is Korea, having only around 1,200 MRI machines or roughly 24 machines per 1,000,000 inhabitants[10]. Having a lesser number of machines available for use means an expected wait time in many other countries. Therefore, wait times in many other countries can exceed two weeks just for a simple scan[11]. In America, though, hospitals need not wait for taxpayer money from the government. As their own business, hospitals may purchase newer, more efficient medical technology in whatever quantities they deem necessary. This is what runs the US healthcare system: the flow of money back into research, not into the people.

Jasen Lau is a third year law student at the University of Baltimore School of Law. He graduated from the University of Maryland in 2013 with a Bachelor of Arts in English. Jasen took it upon himself to become a certified pharmacy technician and studied several continuing education credits that focus on Medicare Fraud and Abuse prevention, HIPAA privacy and security laws, and ethics in the pharmacy workplace. Jasen has long been in the health care field either working directly with patients or as an assistant to providers. During that time, his obsession with working in health care has grown into policy analysis and counseling. Along with being a CICL fellow, he is also a law clerk for Johns Hopkins Hospital.

[1]http://www.forbes.com/sites/gracemarieturner/2012/05/23/though-the-u-s-is-healthcares-world-leader-its-innovative-culture-is-threatened/

[2]42 U.S.C.A. § 18091 (West)

[3]The National Health System for England, The NHS Constitution, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/448466/NHS_Constitution_WEB.pdf (last visited Sept. 1, 2015).

[4]The National Health System for England, Shingles, http://www.nhs.uk/conditions/shingles/pages/introduction.aspx (last visited Sept. 1, 2015).

[5]http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/000674/human_med_001185.jsp&mid=WC0b01ac058001d124

[6]The National Health System for England, Shingles, http://www.nhs.uk/conditions/shingles/pages/introduction.aspx (last visited Sept. 1, 2015). The Center of Disease Control and Prevention, Shingles (Herpes Zoster), http://www.cdc.gov/shingles/about/prevention-treatment.html (last visited Sept. 1, 2015).

[7]Ricardo J. Gonzalez-Rothi, One shingles shot can prevent future pain (2012), available at http://med.fsu.edu/uploads/files/newsPubs/print/Shingles%20shot,%20Gonzalez-Rothi,%20democrat.pdf

[8]The Children’s Hospital of Philadelphia, A Look at Each Vaccine: Shingles Vaccine, http://www.chop.edu/centers-programs/vaccine-education-center/vaccine-details/shingles-vaccine#.VeYv6vlVikp (last visited Sept. 1, 2015).

[9]http://www.hcplive.com/physicians-money-digest/practice-management/negotiating-contracts-with-insurance-companies-fontes

[10]Magnetic Resonance, 21-01 What is the Organ Distribution of MRI Studies?, http://www.magnetic-resonance.org/ch/21-01.html (last visited Sept. 1, 2015).

[11]Martin Beckford, Britain has fewer high-tech medical machines than Estonia and Turkey, The Telegraph (Mar. 30, 2011), http://www.telegraph.co.uk/news/health/news/8413647/Britain-has-fewer-high-tech-medical-machines-than-Estonia-and-Turkey.html.

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Human Trafficking: Not Just an International Problem

Raiven Taylor

Human Trafficking is considered a “modern form of slavery,”[i] carried out by means of transporting, transferring, recruiting, and harboring individuals by means of coercion, abduction, deception, fraud, or abuse of power.[ii] Trafficking is said to generate billions of dollars through an estimated 20.9 million victims, with 1.5 million just from the United States.[iii] It is popular belief that human trafficking is only an international problem, that human trafficking only occurs in third world countries. This is far from the truth. Human trafficking happens all over the United States, even in your own “backyard.” According to the U.S. State Department, the U.S. is “a source, transit and destination country for men, women, transgender individuals, and children…subjected to sex trafficking and forced labor.”[iv]

Did you know that the Super Bowl is the single largest event in the U.S. that hosts the largest populations of trafficked humans?[v] Victims are brought to the city where the event is held and are expected to have sex with a certain number of people. Because of this, Super Bowl cities have attempted to double their training for officers, airport employees, and public service personnel in general, on how to identify and protect a trafficking victim.[vi]

Human Trafficking

The month of September, alone, there have been numerous arrests across the United States for human trafficking. In Ross County, Ohio, police arrested a 36-year-old man as a person of interest in both drug trade and human trafficking in the area.[vii] In Johnson County, Texas, police arrested 16 individuals suspected of human trafficking. The cops entered into a hotel room to find a 44-year old man who was expecting two 16-year old girls. An interview of the man revealed that the man was there to “seize the girls” and to “become their pimp, and prostitute them in Dallas.”[viii]

Earlier this year, a man was arrested in Albuquerque, New Mexico for human trafficking. This man was charged with forcing young girls into prostitution, including a 17-year old girl he found at a bus stop.[ix] After his arrest, the man even continued his trafficking operation while in jail! At trial, the jury found him guilty and the judge sentenced him to 30 years in prison.[x]

The United States is a considered a “Tier 1” country when it comes to human trafficking. This means that the U.S. government fully complies with the Trafficking Victims Protection Act’s (TVPA) minimum standards for the elimination of trafficking.[xi] The government goes to great lengths to investigate and prosecute traffickers. The U.S. also has very high prosecution rates in trafficking. The U.S. has services that are specialized in helping those who were trafficked return to civilization, including a pathway to citizenship for those trafficked from outside of the country.[xii] However, because trafficking still exists, there is still more that the U.S. can do to prevent it..   Both federal and state governments need to create victim-centered policies to ensure that victims are not punished for crimes committed and to ensure support for their health and safety.[xiii]

TraffickingTVPAMap

On the other end of the spectrum, many developing countries such as Cambodia, Cuba, and Kenya are considered “Tier 2 Watch List” or “Tier 3” countries. When countries are considered to be either of these Tiers,  countries are not fully complying with the TPVA’s minimum standards. Tier 2 Watch List countries are known to make some effort into complying with the TPVA’s standards, however the number of victims are significantly increasing. Tier 3 countries are simply those with governments who are not complying with the TPVA’s minimum standards and who are not making efforts to do so.[xiv]

In countries such as Cambodia, Cuba and Kenya, it is important to draft and finalize guidelines on how to prevent trafficking. One of the reasons trafficking is so high in these countries is because these countries are still developing and many areas are poverty stricken. Countries with a higher percentage of poverty lead people to migrate to other countries for a chance of better life, making it a lot easier for traffickers to find victims. Traffickers prey on people who are in search for a “better” life and deceive them with such lies that their dreams will come true, only for them to end up in brothels and forced to have sex or in fields or workshops for forced labor. It is important for countries like these to implement more services to help prevent forced labor and to implement protocols to prevent and protect victims of human trafficking.

In many ways, it may be easier for the U.S. to both implement and carry out such plans. Due to the government structure, which consists of the Department of Justice (DOJ), the State Department, Department of Homeland Security (DHS), Department of Labor (DOL), among others, the U.S. can divide and focus on one aspect of trafficking, whether its reporting, investigating, or prosecuting, and implement plans and share reported data with the other divisions of the government. The U.S. has a system that other countries do not, which may be why the U.S. is considered a Tier 1 country. Although the U.S. is not the only Tier 1 country, the large majority of other Tier 1 countries are developed, with the infrastructure in place to combat and prevent human trafficking. Developing countries often find themselves classified as either Tier 2 or Tier 3 due to the lack of infrastructure, financial resources, and human support and expertise.  With such countries, it is necessary to focus on the root of the problem, namely poverty, to truly combat human trafficking.

Human Trafficking 2

Overall, it is important to know and understand human trafficking so that one may protect themselves and their loved ones from becoming victimized. There is a lot of information on trafficking, and while it may not be necessary to know all of the ins and outs, it is necessary for one to know how trafficking can be prevented and what steps to take. Although the U.S. government has implemented plans on preventing human trafficking, trafficking still happens and has not yet been eliminated.

Everyone can do something to prevent human trafficking. Are you? Find where your state ranks and ways to work with organizations in your area on how to stop human trafficking. http://sharedhope.org/what-we-do/bring-justice/reportcards/

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Raiven Taylor is third year law student at the University of Baltimiore School of Law and is completing her concentration in International Law. She has an undergraduate degree in Political Science from Bowie State University. She has studied abroad in London, England and Clermond-Ferrand, France. She is an Senior Staff Editor for the Journal for International Law as well as Secretary for the International Law Society. Additionally, Raiven is a Rule 16 student attorney in the Immigrant Rights Clinic. Her passion and interest in international law is human trafficking and international human rights law.

[i] https://en.wikipedia.org/wiki/Human_trafficking_in_the_United_States

[ii] https://en.wikipedia.org/wiki/Human_trafficking_in_the_United_States

[iii] http://www.traffickingresourcecenter.org/type-trafficking/human-trafficking

[iv] http://www.state.gov/documents/organization/243562.pdf

[v] http://www.huffingtonpost.com/2014/01/15/human-trafficking-month_n_4590587.html

[vi] http://www.huffingtonpost.com/2014/01/15/human-trafficking-month_n_4590587.html

[vii] http://nbc4i.com/2015/09/10/ross-co-investigators-searching-for-human-trafficking-suspect/

[viii] http://www.wfaa.com/story/news/crime/2015/09/09/johnson-co-human-trafficking-sting-nets-16-arrests–4-days/71968108/

[ix] http://www.koat.com/news/man-sentenced-in-albuquerque-human-trafficking-case/35234566

[x] http://www.koat.com/news/man-sentenced-in-albuquerque-human-trafficking-case/35234566

[xi] http://www.state.gov/j/tip/rls/tiprpt/2013/210548.htm

[xii] http://www.state.gov/documents/organization/243562.pdf

[xiii] http://www.state.gov/documents/organization/243562.pdf

[xiv] http://www.state.gov/j/tip/rls/tiprpt/2013/210548.htm


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No Common Heritage: Why the Internet Cannot be Regulated Like the Sea

Matthew Matechik

In the rapidly unfolding digital age, the strongest player on the international stage is not necessarily the state with the biggest weapons or the most soldiers. Instead it is the cyber actor, which may or may not be a state, capable of most effectively leveraging the Internet to achieve objectives. Like the seafaring captains of old, these actors navigate the labyrinth of the Internet to discover, to trade, to pillage, and to conquer. Digital packets are their vessels. The Internet is their sea.

Internet Pirate

Like the sea, the internet encircles the globe. Like the sea, the Internet is used for benign activity, such as commerce and leisure, but also for destructive activity, such as theft and combat. The sea has sailors and pirates; the internet has cyber professionals and hackers. The comparison seems appropriate and begs the questions: Can international law regulate the Internet like it regulates the sea?

The similarities between the Internet as a medium and the sea as a medium suggest that international principles governing the use of the sea could effectively be applied to the use of the Internet. Upon inspection, however, this theory quickly erodes for numerous reasons. Perhaps the most significant obstacle is the lack of a common heritage to the Internet. Common heritage is the critical component that has allowed the law of the sea to develop.

Customs governing the use of the sea probably began to emerge when humans first encountered other humans at sea. These customs grew out of a recognition that the sea was an incredibly vast shared space that no one nation could hold in the way that land territory could be held. The sea was recognized as the common heritage of mankind. Seafaring parties intersected with both allies and enemies in this shared space. Customs and laws continued to develop over millennia to regulate these encounters. As humanity’s access to the sea increased, international norms increased, including codifying many of these customs in the UN Convention on the Law of the Sea (UNCLOS). These laws were based on the idea that all humans enjoyed freedom of the sea because it was common heritage.  The laws fostered shared use of the sea while deterring nefarious actions on the sea.

As a recent phenomenon, the Internet has no such common heritage, although it has become a common resource. The Internet traces its origins back to a research project completed by the United States Defense Advanced Research Projects Agency (DARPA) during the 1960s.[1] Its usage grew exponentially until it became the truly globe-spanning super network of today, reaching an estimated 3 billion people.[2] Because the United States was the primary driver of early Internet adoption, its infrastructure and usage patterns have developed in such a way that most of the world’s internet traffic passes through the United States.[3] This position offers the United States unique advantages and opportunities that the United States is unlikely to relinquish.

Global Internet Map

Other nations have more recently undertaken measures to ensure their own Internet posture also offers unique advantages and aligns with their interests. For example, China has erected “The Great Firewall” around Chinese Internet users, allowing China to censor which traffic is accessible by Chinese users.[4] China is leveraging its Internet power to further its interests at the expense of internet freedom and access. Meanwhile in the European Union, some European leaders are advocating for new Internet regulations that could bolster European tech companies’ positions against their American counterparts.[5] The fortifying of digital space will not enable the international community to adopt any sort of “freedom of the Internet” measures akin to the freedom of the seas.  Quite the opposite in fact, the trend seems to be increasing restrictions on communal use.

Even if the international community did characterize the Internet as a resource to be shared by all, regulation appears to be technically impossible, at least at present, because Internet traffic cannot be finitely quantified and observed in the same way that seafaring vessels can. Sea regulations are enforceable in large part because nations are able to observe a meaningfully quantifiable number of vessels and react by employing the appropriate legal measure. On the sea, the regulator can, for example, react to nefarious activity by boarding a vessel and searching it.

Over the Internet, the regulator would likewise have to conduct inspections in some manner but there are far too many data packets to deal with. By the end of 2016, an estimated 1,000,000,000,000 gigabytes of data will traverse the Internet annually.[6] That number is too large to fathom its significance. Finding nefarious activity among that much data and reacting appropriately while still fostering Internet freedom is technically impossible given the current state of technology. There are simply too many packets traversing the internet.

The lack of common heritage to the Internet and technological limitations on widespread enforcement make the application of the law of the sea’s principles to the Internet impossible for now. The international community must approach the Internet with a fresh perspective that considers its modern and unique characteristics. The Council of Europe’s Convention on Cybercrime, which entered into force in 2004, is currently the leading international convention in this field. The Convention identifies numerous cybercrimes that signatories must address in their domestic criminal laws, requires that certain law enforcement procedures be put into place, and demands that signatories cooperate to investigate and prosecute cybercrimes.[7] The Convention has been ratified by forty-seven states so far and signed by an additional seven.

The Convention shows some real promise because it addresses uniquely cyber issues and has seen at least some adoption. However, it still lacks global utility because it does little to address state-on-state cyber acts and lacks signatures from significant cyber powers, notably China and Russia. The lack of widespread adoption suggests cyber stakeholders with competing interests have a long way to go before they are able to agree on international regulation that works as effectively as sea regulations.

Matthew Matechik is an Evening J.D. student at the University of Baltimore School of Law (Class of 2016). He currently works full-time for the U.S. Federal Government as a Counterterrorism Analyst. He has a Bachelors of Arts (Magna Cum Laude, 2008) from Florida State University. All views in this blog post are Matthew’s own views and do not represent that of the U.S. Government. 

[1] http://www.internetsociety.org/internet/what-internet/history-internet/brief-history-internet

[2] http://www.washingtonpost.com/sf/business/2015/05/30/net-of-insecurity-part-1/

[3] http://faculty.georgetown.edu/irvinem/CCTP748/Internet-Mediology.html

[4] http://abcnews.go.com/Technology/story?id=4707107&page=1

[5] http://www.reuters.com/article/2015/06/23/us-eu-digital-letter-idUSKBN0P32AX20150623

[6] http://www.cisco.com/c/en/us/solutions/collateral/service-provider/visual-networking-index-vni/VNI_Hyperconnectivity_WP.html

[7] http://conventions.coe.int/Treaty/EN/Treaties/Html/185.htm