Experience Winter 2013

Volume 22 Issue 2  



And Now: The New World of Health Care

I want to begin my first “Leading Remarks” column in Experience magazine during my term as chair by thanking Bruce Alan Mann for his excellent leadership in planning and leading us through last year; Malinda Allen as one of the primary “doers” deserving of recognition for leading the Publications Committee last year after Francis J. Larkin, our former chair, encountered very serious health problems. She, along with Lisa V. Comforty, our new but very experienced staff editor, brought us back on schedule. We are fortunate that Francis’s health has returned and that he will even be able to be the guest editor for an issue on veterans this coming year.

ACA (Health Care Reform)

Does the Affordable Care Act “Cut” Medicare Spending?

Both political parties made the effect of the Affordable Care Act (ACA) on the future of Medicare funding a central issue in the recent presidential campaign. The Republican Party’s candidate warned seniors that the ACA will “cut” Medicare spending by $716 billion, implying that seniors would lose benefits they had enjoyed previously. However, not one political advertisement attacking “Obamacare” or speech delivered by the Republican nominee or his surrogates was able to point to a single example of how a Medicare beneficiary would receive lower benefits, face restricted eligibility, or pay higher costs as a result of the ACA.


Getting a Digital Camera to Record Your Memories

Back in the day, I considered myself a serious amateur photographer. I had a very well-developed system camera (actually more than one) and enough accessories to give most people a hernia if they tried to carry all of them at the same time (I never did). I also ran my own darkroom to process both black-and-white and color film. The world of photography has changed dramatically in recent years, and film has all but died as a medium. Now most photographers (casual snapshooters, serious amateurs, and professionals) use digital cameras. The electronics of digital cameras give almost anyone the ability to take a properly exposed picture, whether or not they know what they are doing. Software in and out of the camera also lets you fix exposure and other problems with amazing ease.

Trusts & Estates

Introduction to Accounting for Trusts and Estates Part II: Estates

Tax regulations applicable to estates and trusts are very complicated. Common questions include what is taxable, when is it taxable, and is the trust or estate taxed or is it the beneficiary or grantor who is responsible for the tax? Many other questions arise, as well. In this column, we resume the discussion of accounting for trusts and estates that we began in the last issue. See Introduction to Accounting for Trusts and Estates, Part I: Trusts, 22 Experience, no. 2, 2012, at 42. We move on to our examination of estates.


The ACA A Physician’s Perspective

I am a geriatrician, a doctor who specializes in the care of older adults. I am board certified in family medicine, geriatric medicine, and hospice/palliative medicine. For 18 years, I have been caring for older adults and people with chronic diseases. I have an active house calls practice in which I see homebound seniors who cannot access primary care because leaving their homes is a burden to them or their families. I know first-hand the problems associated with a fragmented, acute-care-focused health insurance system that costs too much, covers too little, and excludes too many. It also does not match the needs of older adults or people with chronic medical problems who require more than just 15 minutes with their primary care provider. Sometimes I can’t get through my patient’s medication lists in 15 minutes! Individuals with complicated needs often require team-based care, as many of their problems are not just biomedical in nature but are, rather, intertwined with social and psychological issues.


The Affordable Care Act after the Supreme Court’s Ruling

The United States has long had the most expensive healthcare system in the world. Our national health-related spending has accounted for almost one-fifth of the gross national product, or several trillion dollars, which is far more than in any other country. Yet, there has been little correlation between the money paid for health care in America and the effectiveness of the American healthcare system, which former Senator Daschle once described “as islands of excellence in a sea of mediocrity.” Tom Daschle, Prospects for Health Care Reform in 2009, 27 Yale L. & Pol’y Rev. 173, 176 (2008). A comparison of health outcomes in other countries shows that the United States ranked twenty-eighth out of 37 countries in infant mortality and thirty-first in life expectancy among 192 other countries. The Save the Children Foundation ranked the United States twenty-second in the world on women’s health, twenty-seventh on mothers’ health, and thirty-third on children’s health—behind Poland, Slovakia, and Latvia.

ACA (Health Care Reform)

The “Dual Eligible” Medicare-Medicaid Enrollee Demonstration: Can It Both Improve Care and Save Money?

Can states develop programs to improve care for Medicare-Medicaid “dual eligible” enrollees—who have the most intensive and costly health needs—and, at the same time, save money? That is the gamble to be played out in a mammoth, multistate, federal demonstration program under the Affordable Care Act. With the re-election of President Obama, this large-scale experiment in healthcare delivery is likely to forge ahead—and it’s important to understand what is at stake.


What Should Lawyers Know about Advance Directives for Health Care? A Geriatrician Speaks Out

A common response from many physicians to the question of what should lawyers know about advance directives for health care would be something along the lines of, “tell your clients to talk with their doctors about it,” because creating an advance directive is a medical, not a legal, endeavor. The argument goes, who better to talk with patients about their future treatments than the physicians charged with caring for them during those difficult times? But, despite the move to make creating advance directives an increasingly medical practice, evidenced by the as-yet unsuccessful campaign to make it a billable medical procedure, I hope to show that lawyers still have an important role to play. In my (admittedly minority) opinion, this role involves helping clients understand that choosing a good person to be one’s power of attorney for health care should take precedence over signing forms indicating which medical procedures to have or not have in the event of incapacity. The reason is that these forms often do not produce their intended results. Instead, patients can end up being given either too much futile medical intervention or too little beneficial care.