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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Pope Francis: The Diplomatic, Modern Catholic Reformer

Suzanne De Deyne

The Catholic Church is a global entity with over a billion members and at the head of the Catholic Church is Pope Francis. The Catholic Church is arguably the world’s oldest diplomatic service and, due to its vast network of humanitarian aid organizations, it has a unique ability to shape foreign policy in a way no other institution can. This blog post seeks to describe how Pope Francis’ mission to change the world and the overall perception of the Catholic Church rises to a level of international significance.

splash-mission

Pope Francis is the sovereign leader of the Catholic Church. The Catholic Church (‘Holy See’) is recognized as a Permanent Observer at the United Nations. It does not meet the required elements of statehood but has acquired an international legal personality. The mission of both the UN and the Catholic Church is to assist in the protection and promotion of peace, equality, and human rights.[1] As a Permanent Observer, the Catholic Church has the right to participate in the UN’s General Assembly debates and contribute to proposals, position papers, and draft resolutions and decisions.[2] If the Catholic Church acts as a promoter of peaceful transnational cooperation under the rule of law, there is an argument to be made that the Catholic Church’s input is merely a symbolic gesture that seeks to set an example, even if it is left unnoticed by others (i.e. the P5). This allows the Pope to guide world powers toward a particular vision of justice and peace.[3]

As head of the Catholic Church, Pope Francis acts as a moral legislator and an ecclesiastical regulator where his influence extends to all countries. So how much power does Pope Francis have over religious souls? A few decades ago, the Catholic Church mandated a firm commitment to its positions and straying with the Church’s policies meant committing a moral sin, inflicting the fear of hell in its followers. Today, (American) Catholics are more educated and the Church has allowed Catholics to draw independent conclusions. This transition is particularly relevant on a political spectrum. When John F. Kennedy ran for President, Protestant leaders challenged that he would be a tool of the Vatican and concerns about Catholic leaders demanding political loyalty on issues involving church doctrine were widespread.[4] Today, the question is whether Catholic voters and Catholic politicians still give deference to Vatican views when it comes to pronouncements politicians make on key issues?[5]

During a morning homily, Pope Francis stated, “the church asks all of us to change certain things.”[6] Throughout his papacy, he has attacked the narrow-mindedness of the Catholic hierarchy for focusing too much on dogma and “spiritual worldliness,” and too little on ordinary people. Pope Francis frequently speaks deeply in personal terms on topics such as how people are discarded by the global economy, refugees who have drowned at sea, women forced into prostitution, and critiques of environmental destruction.[7] Recently, he publically alluded to a more welcoming attitude toward homosexual by saying, “Who am I to judge?”.[8] Pope Francis has also refuted capitalism as a false ideology that focuses on excess and is inadequate for fully addressing the needs of the poor. For Pope Francis, the answers are found with the Gospel, not with Adam Smith or Karl Marx.[9] Chancellor of the Pontifical Academy of Sciences, Monsignor Sánchez Sorondo stated, “the pope, of course, doesn’t have a solution — the economic solution but the pope is like a light on the street to say: ‘This is not the way.”[10]

19FRANCIS-SS-slide-0W6G-superJumbo

To be recognized as an exemplary and a transformative leader, one must model the way, encourage the heart, enable others to act, embody a shared vision, and challenge the process and the status quo.[11] Pope Francis has been immensely revolutionary and transformative in all of these regards.[12] He is remaking modern Catholicism by concentrating the church’s core competence on helping the poor, rebranding the church by changing the message communicated by prioritizing deeds over words, and restructuring the church across all levels of influence.[13] Pope Francis’ push to change the Catholic Church has created anxiety and hope. Guzmán Carriquiry Lecour, secretary of the Pontifical Commission for Latin America and a longtime friend of the pope stated, “He is very critical of ideology because ideologies come from intellectuals and politicians who want to manipulate the hearts of the people. For him, ideologies hide and defame reality.”[14] Yet through gestures and words, Pope Francis has repeatedly challenged elites, both inside the church and out. His humble persona has made him immensely popular and his mission of helping the poor seems to exceed the religious limitations of the Catholic Church – Pope Francis wants to reach the people of the world.

Suzanne De Deyne is a third year student at the University of Baltimore School of Law (candidate for J.D., May 2016) concentrating in International Law. Suzanne graduated cum laude from the University of Massachusetts-Amherst with a Bachelor of Arts in Political Science and a minor in Economics. She also received a  Honor’s International Relations Certificate from Mount Holyoke College. Currently, Suzanne is the Managing Editor on the Journal of International Law and is President of the International Law Society. As a CICL Fellow, Suzanne has conducted legal research for International Rights Advocates on human rights and corporate accountability. She is also a member of the Women’s Bar Association and Phi Alpha Delta. This past summer Suzanne was a legal intern at Gibson, Dunn, & Crutcher in the firm’s Brussels office, which is focused on Competition Law practice in Europe.

[1] Discover the Mission, The Permanent Observer Mission of the Holy See to the United Nations (2015), http://www.holyseemission.org/contents//mission/discover-the-mission.php

[2] Id.

[3] Edward Pentin, The Pope as Diplomat, Foreign Affairs (Feb. 27, 2013), https://www.foreignaffairs.com/articles/2013-02-27/pope-diplomat

[4] Tom Gjelten, Modern Catholics Test the Pope’s Infallible Authority, NPR (Sept. 4, 2015), http://www.npr.org/2015/09/04/437597038/modern-catholics-test-the-popes-infallible-authority

[5] Id.

[6] Jim Yardley, A Humble Pope, Challenging the World, N.Y. Times, Sept. 18, 2015, http://www.nytimes.com/2015/09/19/world/europe/pope-francis.html?_r=1

[7] Id.

[8] Id.

[9] Id.

[10] Id.

[11] Stan Chu Ilo, Pope Francis and the Remaking of Modern Catholicism, Huffington Post (Mar. 12, 2015), http://www.huffingtonpost.com/stan-chu-ilo/pope-francis-and-the-remaking-of-modern-catholicism_b_6852468.html

[12] Id.

[13] Id.

[14] Supra note 6.

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Does Universal Healthcare Fix Racial Disparity in Healthcare? Investigating France

Jasen Lau

Racial disparity still infects the US healthcare system.[1] To counter this disparity, many suggest that an universal healthcare will solve the issue, and to a certain extent, that may be true. If the true issue in the disparity is merely access to physicians, universal coverage will solve the racial disparity. However, disparity is not solely reliant upon access to medical coverage. For if the only issue in racial disparity in healthcare is merely access, then, logically, all nations with universal healthcare should have no racial disparity. Turning to France, touted as having the best healthcare system in the world,[2] studies show that racial disparity still exists in France despite having the best universal healthcare.

Assuming racial disparity in healthcare is purely about access to medical coverage, analyzing France is the first step to finding out if improving access would solve racial disparities in the US. Even now, there are French health institutes that do not have properly implemented protocols to handle what the article calls “migrants.” One primary concern is how to properly administer health when the patient, being foreign and “migrant,” does not speak French. A natural thought process would be to have an interpreter available, but the article indirectly suggests that there is no policy to implement such a service.[3] Granted, the patient may bring their own interpreter, but of course, this assumes the patient has one on hand and ready or can even afford one. Curious, too, is that certain French health institutes are attempting to find a balance between accommodating for cultural differences while making an extra effort to ensure the facility is not associated with any one particular religion or culture.[4] As an example, if a French hospitals treats Islamic patients, that institute must respect certain dietary or religious preferences out of respect for the patient. In that situation, the hospital must be Islamic friendly without being associated with the particular Islamic race. This, too, leads to certain issues.

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Allegedly, patients discriminating against hospital staff is an ever rising issue.[5] Patients refuse to be treated by certain providers based either the race, gender, or even sexual orientation. This, of course, inhibits the healthcare system if certain providers must be found in order to accommodate a racist, patient request. This extends to other services by the hospital, too: food, routine examinations by technicians, pharmaceutical intervention, and so forth. Quite in fact, one determining factor of those who are most at risk for healthcare disparity is the religious region from where the patient hails.[6] There is clearly racial disparity in France. While access to healthcare may be solved in France, access, in of itself, is not the sole source nor even the primary source of racial disparity in healthcare.

Understanding healthcare requires a broader sense of the word. A truer definition of current healthcare involves socioeconomic factors: poverty, living conditions, and education. In France, there is no study which directly correlates poverty to minorities. However, there is no doubt that migrants and foreigners, who have been historically disadvantaged, are most likely subjected to poverty, unsanitary living conditions, and a lesser likelihood of employment.[7] This historic and systemic disadvantage has left the foreigners and immigrants to a poor self-image, having a lower opinion of their own health despite having adjusted for all socio-economic factors.[8] This leads to further doctor visits of whom, as stated above, will have continued problems treating those patients, and the cycle repeats itself. Similar analysis must be taken into account in the US.

A brief study of the early 20th century reveals that the greatest innovation of healthcare did not involve the practice of medicine. Despite the discovery of penicillin in 1928,[9] above the creation of the polio vaccine in 1952,[10] and more impactful than gene therapy in 1985,[11] clean water and plentiful food have had more impact to general health than any form of medical treatment to date. With the advent of plentiful food and clean water, diseases have decreased in occurrence[12] and have much later dates of onset.[13] Yet, the pervasive fact remains that racial disparity exists, leaving the last key factor in question: socioeconomic factors. There is no contest that the most poor, most uneducated, more residentially unstable are minorities.[14] Perhaps access is not the biggest issue of healthcare today.

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Perhaps, then, racial disparity in healthcare is an issue far beyond just access to the clinic or the pharmacy. Perhaps racial disparity is much more systemic and beyond merely the Department of Health and Mental Hygiene. Perhaps, just perhaps, an unfair system – disfavoring minorities – is a root cause of racial disparity in everything and not just healthcare.

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.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/nhqdr14/2014nhqdr.pdf ; see also http://www.cdc.gov/mmwr/pdf/other/su6203.pdf

[2] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447687/#r5

[3] https://www.ifri.org/fr/publications/editoriaux/diversite-lhopital-identites-sociales-discriminations

[4] Id.

[5] http://faceaface.revues.org/344

[6]http://www.sherpa-recherche.com/wp-content/uploads/2015/01/FS-Racisme-et-discriminations-contexte-SSS.pdf

[7] https://remi.revues.org/5611

[8] Id.

[9] http://www.ars.usda.gov/Research/docs.htm?docid=12764

[10] http://www.cdc.gov/vaccines/vpd-vac/polio/default.htm

[11] https://history.nih.gov/exhibits/genetics/sect4.htm

[12] David M. Cutler & Grant Miller, The Role of Public Health Improvements in Health Advances: The Twentieth-Century United States, 42 Demography 1, 6 (2005); the amount of diseases both water-borne or otherwise significantly decreased as the 20th century progressed with the implementation of water treatment

[13] Robert W. Fogel, Secular Trends in Physiological Capital: implications for equity in healthcare, 46 Perspectives in Biology and Med. S24, S33 (2003); many diseases were much less prominent in younger people. For example, arthritis started occurring in those above 60 years of age instead of mid-50’s

[14] Robert J. Sampson, The Neighborhood Context of Well-Being, 46 Perspectives in Biology and Med. S53, S54 (2003).


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Where Would You Rather Be? Protections of Victims of Human Trafficking

Raiven Taylor

The U.S. State Department keeps track of the annual numbers of trafficking victims in each country throughout the world. The State Department not only keeps track of the victims found, but also the laws of preventing trafficking, protecting victims, and prosecuting traffickers. There are a number of countries that help, in various ways, protect trafficked victims from re-victimization, while other countries do nothing at all The United States is a Tier 1 country, which simply means the government fully complies with the minimum standards to eliminate human trafficking.[i] (The last blog post goes into greater detail on the Tier categories).

The U.S. has standards in place to protect victims of human trafficking. It created the Trafficking Victims Protection Act (TVPA) to establish methods of not only protecting trafficked survivors, but also to prosecute traffickers and and prevent trafficking.[ii] The Act provides protections involving identifying victims, providing shelter and medical care, and repatriation.[iii] The Act authorizes the Department of Homeland Security (DHS) to permit a human trafficking victim to remain in the U.S.[iv] This is done through the T-Visa. This visa allows victims to become temporary residents that may allow them to become eligible for permanent residency after three years. [v]The TPVA also offers protections by making trafficked victims eligible for witness protection programs as well as other federal and state benefits to the same extent as refugees.[vi]

TVPRA

The TPVA also attempts to protect unknown victims of trafficking. The 2008 provisions of the Act require unaccompanied minor children to be screened as possible trafficking victims and to then be transferred within 48 hours to the custody of Health and Human Services.[vii] In other forms of protection, the U.S. has federally funded victim assistance case management. The case management includes referrals to resources such as: dental and medical care, employment and training services, substance abuse treatments, and many more, including advocacy.[viii] The funding for victim assistance was increased by the Department of Health and Human Services’ (HHS) Office of Refugee Resettlement (ORR). HHS enabled trafficking victims of other countries the same benefits as Refugees.[ix]  In 2013, about $7.9 million dollars went to 19 victim services across the U.S..[x]

Trafficking Blog 2

Even though the U.S. seems to do a lot, especially in funding victim services, there are non-governmental organizations (NGO) that still believe the government could do more. NGOs have concerns that the U.S. does not consistently take the victim-centered approach that it should.[xi] A victim-centered approach is an approach taken that “seeks to minimize re-traumatization associated with the criminal justice process by providing the support of victim advocates and service providers, empowering survivors as engaged participants in the process, and providing survivors an opportunity to play a role in seeing their traffickers.”[xii] There are also concerns that the employees that handle victims do not have proper training and guidance to provide the critical support that some victims need.[xiii]

Although the U.S. has things it could work on to better improve the protections offered to victims, there are other countries that do not do half of what the U.S. does. For instance, Cuba is a Tier 3 country and does not fully comply with the minimum standards of eliminating trafficking. The Cuban government has not officially reported on its protections of trafficked victims nor did it report the procedures it has in place to protect victims or guide officials in identifying victims. However, the government does have shelters for victims, although it does not keep track or verify that the victims actually receive any kind of assistance for treatment.[xiv] Recommendations for Cuba consist of: strengthening its efforts to provide special training for police and social workers to protect trafficked victims, build clear procedures on identifying victims, and continue funding victim-centered practices.[xv]

Human Trafficking BarCode

It is reported that Cuba does not comply with the minimum standards because the government is involved in human trafficking.[xvi] Cuba has offered its opinion in statements stating that this is not happening within its government. However, these statements come from very biased individuals. Cuba has been a Tier 3 country for the last twelve years and continues to not comply with standards. Although Cuba is just one of many countries that are considered a Tier 3 country, it is always difficult to tell if these countries fall in this category by choice or because they do not have the means to be able to rise out its condition. Cuba continues to tell the U.S. government that it will do better year after year, however it is never shown in their reports.

Another example is Cambodia. Cambodia was placed on the Tier 2 Watch List.[xvii] According to the State Department, Cambodia’s government has procedures in place to identify victims and refer them to NGOs. However, Cambodia is on the Tier 2 Watch List because the amount of victims identified continues to decline.[xviii] Cambodia has government operated shelters to take in victims of trafficking, but once the victims arrive, the government has very little to do with further assisting them.[xix] The majority of assistance given to trafficked victims (medical, legal, shelter, and vocational services) in Cambodia is administered by NGOs in Cambodia, instead of the Cambodian government.[xx] However, there have been reports that some NGO shelters subject their victims to even more abuse and that they cannot provide the victims adequate care.[xxi] The Cambodian government has no policy in place that allows trafficked victims to stay in the country. Victims that come from other countries are sent back to their home country without any legal alternatives.[xxii] Recommendations for Cambodia would be to create legal practices that first involve keeping victims from being returned to the county they were originally trafficked from. Another recommendation would be to give employees of shelters a practical training on how to deal with trafficked victims, as well as hire people whom are willing to help instead of re-traumatize victims. A third recommendation would be for the government to be more involved in the protection of trafficked victims instead of identifying them and completely handing them over to NGOs.

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Overall, although human trafficking is a huge issue no matter what country is being discussed, it does not go unseen. Regardless of the Tier, each country has some kind of issue in trafficking. However, the important thing is that something is being done to resolve and prevent the issue from happening. Also, this proves that just because a country is considered a Tier 1 country, does not mean that they cannot improve on ways to protect victims. However, Tier 1 countries such as the U.S., are considered to have the best practices such as shelter, medical care, and other assistance that aims to keep victims safe and free from being re-trafficked, and it should be required that all countries find a way to implement the same kind of practices.

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] http://www.state.gov/documents/organization/226849.pdf

[ii] https://www.polarisproject.org/what-we-do/policy-advocacy/national-policy/current-federal-laws

[iii] http://fightslaverynow.org/why-fight-there-are-27-million-reasons/the-law-and-trafficking/trafficking-victims-protection-act/trafficking-victims-protection-act/

[iv] https://www.congress.gov/bill/113th-congress/house-bill/898

[v] http://www.rescue.org/sites/default/files/resource-file/trafficking%20victims%20protection%20act%20fact%20sheet_0.pdf

[vi] Id.

[vii] Id.

[viii] http://www.state.gov/documents/organization/226849.pdf

[ix] Id.

[x] Id.

[xi] Id.

[xii] https://www.ovcttac.gov/taskforceguide/eguide/1-understanding-human-trafficking/13-victim-centered-approach/

[xiii] http://www.state.gov/documents/organization/226849.pdf

[xiv] http://www.state.gov/j/tip/rls/tiprpt/countries/2013/215447.htm

[xv] http://www.state.gov/documents/organization/226845.pdf

[xvi] http://www.huffingtonpost.com/salim-lamrani/cuba-the-united-states-an_b_5604799.html

[xvii] http://www.state.gov/documents/organization/226845.pdf

[xviii] Id.

[xix] Id.

[xx] Id.

[xxi] Id.

[xxii] http://www.state.gov/documents/organization/226845.pdf


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Displacing Santa: Russia Claims the North Pole

Matthew Matechik

Russia Asserts Exclusive Economic Rights to Massive Section of Arctic Ocean

Russia owns the North Pole. At least… Russia claims it owns the resources of the North Pole. When it comes to expanding its territorial influence, Russia has been busy lately. Invade a neighbor here,[i] illegally annex some territory there,[ii] and violate airspace elsewhere. [iii] Russian President Vladimir Putin’s latest foray is a resource claim to a vast swath of the Arctic Ocean, including North Pole.

Russia North Pole

To be fair, Russia is at the moment making this grab via lawful means unlike, for example, its illegal annexation of the Crimean peninsula. Russia has made its claim under the 1982 U.N. Convention on the Law of the Sea (UNCLOS).[iv]  UNCLOS defines coastal states’ claims to adjacent waters. Under the treaty, a coastal state has exclusive economic rights, meaning sole access to and control of all the resources, in waters extending 200 nautical miles from its coast. UNCLOS also allows a coastal state to claim exclusive economic rights over any part of the ocean over the continental shelf protruding from the coastal state. Continental shelf rights can exist beyond the EEZ up to 350 nautical miles from the coast if the coastal state can establish that the foot of the continental slope exists that far out[v]. The EEZ and continental shelf areas are not part of the state’s territory, although they are immensely valuable to the state because the state alone has access to all the resources, such as oil and fish, and can prohibit other states from accessing those resources.

Russia claimed in August that the foot of its continental slope exists 350 nautical miles, and possibly even further, from its coast. Therefore, Russia is entitled to exclusive economic rights that far from its coast.[vi] The claim far exceeds current understandings of arctic exclusive economic rights, which limits Russia to the outer limit of the EEZ. If Russia’s claim is valid then Russia has exclusive economic rights to over 460,000 square miles of the Arctic Sea, including the North Pole, all of which is currently classified as international waters. The area is estimated to contain up to 10 billion tons of oil and gas deposits, as well as large fisheries, and vast reserves of diamonds and valuable metals such as gold, tin and platinum.[vii] In addition, major potential shipping routes are emerging as global warming melts the polar ice caps. It’s not surprising that Russia wants to control this area itself given its significant economic importance, strategic advantage, and increasing accessibility.

Russia North Pole 2

Russia has been building toward this claim since at least 2002 when it filed a similar UNCLOS claim which was rejected for lack of scientific evidence.[viii] Since that time Russia has been amassing what its Foreign Ministry claims is “a broad range of scientific data collected over many years of Arctic exploration” to support its argument that the continental foot exists 350 miles from shore.[ix] Russia was not shy about asserting its North Pole presence while it was gathering all that evidence. In 2007, Russia dispatched a well-known Russian explorer in a submarine to the seabed directly below the North Pole where he took a soil sample and planted a Russian flag made of titanium.[x] More recently, last March Russia asserted its military strength in the area with a massive exercise involving over 40,000 servicemen, 41 warships, and 14 submarines.

The U.N. Commission on the Limits of the Continental Shelf will deliberate Russia’s claim at its next session.[xi] The Commission must consider if Russia’s newly presented evidence is enough to grant Russia the exclusive economic rights it desires. Russia will likely have to have a far more convincing case than it did in 2002.

Russia North Pole 3

Not to be outdone in the race for a treasure of resources and shipping routes, the United States, Canada, Norway, and Denmark all have their own claims to exclusive economic rights in the Arctic, many of which extend beyond the EEZ. (It should be noted that the United States has not ratified UNCLOS.) As the ice melts, all the bordering states are looking to take advantage. The competing interests make the cold North Pole a potential hot spot for violent conflict.[xii] The potential for Arctic conflict is certainly amplified if the U.N. denies Russia’s claim as expected. Or, for that matter, if the claim is approved, then the United States, Canada, Norway, and Denmark will be forced to do something to hang on to their power in the Arctic. Russia is certainly capable of using force, or at least forceful deterrent, to protect what it views as its exclusive Arctic resources. Russia has proven in Crimea that it is willing to violate international law to expand its territory and power even in the face of punitive sanctions. Amidst increasing tensions in the Ukraine, Syria, the Balkans, and elsewhere, Cold War rivalries might finally heat up to hostilities in the Arctic.

Matthew Matechik is an Evening J.D. student at the University of Baltimore School of Law (Class of 2016). He currently works full-time as a Counterterrorism Analyst. He has a Bachelors of Arts (Magna Cum Laude, 2008) from Florida State University.

 

[i] http://knowmore.washingtonpost.com/2014/03/05/a-map-of-the-last-time-russia-invaded-one-of-its-neighbors/

[ii] http://www.cnn.com/2014/03/18/world/europe/ukraine-crisis/

[iii] http://www.nytimes.com/2015/10/07/world/europe/russian-violations-of-airspace-seen-as-unwelcome-test-by-the-west.html

[iv]  http://www.un.org/Depts/los/convention_agreements/convention_overview_convention.htm

[v] http://www.un.org/Depts/los/clcs_new/continental_shelf_description.htm

[vi] http://www.cnbc.com/2015/08/06/move-over-santa-putin-claims-the-north-pole.html

[vii] http://www.livescience.com/4584-russia-claims-north-pole-global-race-oil.html

[viii] http://www.smithsonianmag.com/smart-news/russia-might-own-north-pole-180956208/?no-ist

[ix] http://www.nytimes.com/2015/08/05/world/europe/kremlin-stakes-claim-to-arctic-expanse-and-its-resources.html?rref=collection%2Fsectioncollection%2Fscience&action=click&contentCollection=science&region=stream&module=stream_unit&contentPlacement=3&pgtype=sectionfront&_r=0

[x] http://www.nytimes.com/2007/08/03/world/europe/03arctic.html?_r=0

[xi] http://www.un.org/depts/los/clcs_new/commission_submissions.htm

[xii] http://blogs.reuters.com/great-debate/2015/10/04/russia-and-america-prep-forces-for-arctic-war/

 

 


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Research and Public Welfare: Working with the French, We Can Have Our Cake and Eat It Too!

Jasen Lau

The US healthcare system is a system that ultimately prioritizes research. However, that is not to say we cannot have public universal healthcare. No system can offer absolute public welfare without taking away funding from research, but there can be a system that doesn’t take away as much. Keeping the research oriented priorities in mind, the US can still adopt a sort of inverted French healthcare system to provide public universal healthcare without significantly hindering medical and pharmaceutical research.

carte-vitale-cmp

The World Health Organization praised France for having the best healthcare system in the world[1]. Indeed, they are often touted as having the closest to perfect system in terms of patient satisfaction[2], and their system works because it is regulated but not socialized. The French healthcare system is delivered through their Social Security(SS), and financing their SS works much like ours; much of the money for SS comes from income and payroll taxes. This money is then used to insure patients through general funds, and this general fund covers around 70% of all expenses[3]. The rest of the amount owed is either paid out of pocket or through the more popular choice of voluntary insurance. This voluntary insurance works much like the private payer of the US and is often offered through employment. So, on paper, it seems that the French have most or even all of their healthcare costs covered, which is true[4]. However, the French government plays a big role in these prices.

Unlike the US, the French regulate and control the costs of medical services, products, and pharmaceutics. For example, doctors are often paid much less in France than the US[5]. So, these lowered costs are more easily covered by both the public insurance and the voluntary insurance. Therefore, to follow any model of the French healthcare system, some regulation of costs would be necessary. For the US, and to preserve the goal of research rather public welfare, absolute regulation is not necessary – just some to limit the financial burden on the government.

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Rather than having SS pay for the majority, the US could complement private insurance. Of course, this would require that the person have insurance in the first place, now mostly possible due to the Affordable Care Act (ACA) and its individual mandate, requiring everyone to have insurance or suffer penalties. Therefore, the US need only cover the gaps not paid by the private insurer. Further, the US government would also have to regulate either insurance payment or cost. To avoid significantly hindering research in the US, regulating insurance payments would not interfere with funding research. To regulate costs means to ask physicians, medical technology manufacturers, and pharmaceutical companies to relinquish money from funding in order to serve the public welfare. Thus, the US can adopt an inverted French healthcare system and regulate insurance companies to achieve a public universal healthcare.

With the ACA requiring everyone to have insurance, the first step of this proposal is met: almost everyone will have some level of insurance. The person will have their choice of what insurance to get, but to get people to choose the right insurance, the patient will have to pay premiums and some amount of copayment for services. After all, if there is absolutely no cost to the patient, everyone in the nation will, undoubtedly, choose the best – and often most expensive – coverage policy. However, if that is the scenario, that the patient should able to afford such prime insurance that all needs and wants are fully covered, then there is no need for that patient to be a part of the supplemental SS insurance. Perhaps, in those situations, a tax break could be offered. Otherwise, SS can then pay for coverage gaps in a person’s private insurance, and such funding will come from where it always has: mainly payroll and income taxes and, if need be, subsidy by other government bodies. Now, the SS payment need not cover all copayments or costs. In France, patients still have copayments, though they may simply be an extraordinary low[6]. The US can and should follow suit. The key costs to keep would be insurance premiums. To avoid excessive costs to both the healthcare system as a whole and to the supplemental SS system, patients should be made aware to buy only what is necessary to their needs. This, again, is to emphasize the concern patients must establish in choosing healthcare. Putting in baseline copayments – even if nominal – will tell the patient what can be considered a costly or non-preferred treatment.

There will need to be some insurance regulation. For if there is no insurance regulation, insurance companies court contract with providers to let the federal government bear the financial burden instead of the private insurance. So, there has to be some regulation that deters or otherwise prohibits insurance companies from diverting costs from themselves. There can be no solid solution without great deliberation, but a good starting point would be a percentage coverage regulation. Such a regulation would require that the insurance cover some reasonable amount that does not greatly deviate from what they would cover had the patient not have a federal gap coverage plan. As for physicians, reimbursement rates would be on par with Medicaid or medicare reimbursement rates, relatively low[7]. On that note, this plan would take the place of Medicare but not in the place of Medicaid. Like the US Medicaid, French Social Security offers healthcare to those who are poor[8]. The poor would not have the option to purchase private insurance to later be supplemented by SS coverage. Medicare however, is not inherently for the poor, merely the elderly, the permanently disabled, and those with end-stage renal disease.[9] So, Medicare should be replaced with this proposed private-SS coverage plan.

The general French system offers coverage for those who have worked. Those who are poor or have not worked at all are given a special fund for their coverage, often subsidized by the wealthy and working. Implementing this in the US, states could keep their Medicaid, of which the federal government subsidizes. However, Medicare will be eliminated and replaced with this proposed inverse French Healthcare system. Though, no significant harm shall come of this. Private insurance companies can and will step in to cover seniors with specific plans designed to cater to the medical needs of the elderly. In fact, much of that already occurs now. Medicare Part C is a plan handled almost exclusively by a private insurer instead of Medicare. When an elderly patient needs a plan that caters to their personal needs – of which Medicare cannot meet – patients are able to seek out Medicare Part C plans through private insurers[10]. Therefore, this inverted French plan is no different than putting every elderly person on Medicare Part C. There are, however, some elderly patients who are unable to afford private insurance. In the US, about 10% to 11.5% of those above 65 live below or at the poverty line[11]. For those patients, Medicaid would apply. This way, the vast majority of the population will be covered without extensive inhibitions to research funding.

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An inverted French healthcare system can benefit the general welfare of the US. Granted, this does come at a slight cost to funding research. The coverage gap, of which would have been normally paid in full out of the patient’s pocket, is now paid at a lesser rate due to this proposed federal coverage gap insurance. However, this is a small cost to pay for the public welfare of the US citizens.

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.who.int/whr/2000/media_centre/press_release/en/

[2]http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447687/#r5

[3]http://www.npr.org/templates/story/story.php?storyId=92419273

[4] Id.

[5]http://prescriptions.blogs.nytimes.com/2009/09/11/health-care-abroad-france/?_php=true&_type=blogs&_r=0

[6]http://www.slate.com/articles/business/dispatches_from_the_welfare_state/2014/01/french_socialized_medicine_vs_u_s_health_care_having_a_baby_in_paris_is.2.html

[7]http://www.forbes.com/sites/merrillmatthews/2015/01/05/doctors-face-a-huge-medicare-and-Medicaid-pay-cut-in-2015/

[8]http://www.npr.org/programs/day/features/2008/jul/france/dutton.pdf

[9]https://www.cms.gov/medicare/eligibility-and-enrollment/origmedicarepartabeligenrol/index.html

[10]https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html

[11]https://www.americanprogress.org/wp-content/uploads/issues/2008/07/pdf/elderly_poverty.pdf; see also http://kff.org/other/state-indicator/poverty-rate-by-age/