Anyone who understands systems will know immediately that optimizing parts is not a good route to system excellence.…We connect the engine of a Ferrari, the brakes of a Porsche, the suspension of a BMW, the body of a Volvo. What we get, of course, is nothing close to a great car; we get a pile of very expensive junk.
~Atul Gawande, The Checklist Manifesto
Marriage equality moved into the heart of Dixie late yesterday with a ruling in Mississippi. US District Court Judge Carlton W. Reeves’s ruling struck down Mississippi’s constitutional amendment banning same-sex mariage, saing that the amendment denying the freedom to marry to same-sex couples unconstitutional. In his decision, Judge Reeves put the ruling on hold for 14 days pending an appeal by the state. State attorneys have already said they will ask the 5th U.S. Circuit Court of Appeals to block Reeves’ order; the 5th Circuit will now have 3 marriage equality cases to hear. An additional case in Mississippi challenging the state marriage ban filed in state court – Czekala-Chatham v. Melancon – is currently on appeal to the Mississippi Supreme Court.
In separate news, a federal judge in Arkansas also ruled in favor of marriage equality yesterday hours before the ruling in Mississippi. I’ve previously mentioned marriage equality in Arkansas, however that was a state circuit court case which is currently under review by the state’s Supreme Court. Yesterday, US District Court Judge Karen Baker ruled in favor of the freedom to marry in Arkansas, declaring the state’s Amendment 83, which limits the freedom to marry to different-sex couples, is unconstitutional.
Judge Baker stayed the ruling, so no marriages will take place while the state decides whether to appeal to the Eighth Circuit Court of Appeals.
At the heart of liberty is the right to define one’s own concept of existence, of meaning, of the universe, and of the mystery of human life.
~US Supreme Court Justice Anthony Kennedy in Planned Parenthood v. Casey
I could write a long diatribe about the events surrounding the death of Michael Brown, the subsequent grand jury decision not to indict Officer Wilson, and the unrest in Ferguson both after Michael’s death and last night after the release of the grand jury decision. I could write about violence, race, and police authority in this country. And I still might, but the words escape me at the moment.
Instead, I’m going to take my cue from Michael Brown’s parents, who throughout this ordeal have implored the public to maintain calm. The last line of their statement regarding the grand jury’s decision is both telling of their strength following the death of their son and of the greater call to all of us to change that which we see as unjust in this nation.
Let’s not just make noise, let’s make a difference.
Surgery is a profession defined by its authority to cure by means of bodily invasion. The brutality and risks of opening a living person’s body have long been apparent, the benefits only slowly and haltingly worked out.
~Atul Gawande, MD, MPH
It seems like every time I come up with a good health policy post, marriage equality momentum moves forward as well. That said, I’m not complaining.
U.S. District Court Judge Brian Morris struck down the ban on marriage between same-sex couples today in Montana, ruling in favor of the freedom to marry. Judge Morris’ ruling is set to take effect immediately.
Shortly after the decision, the Montana Attorney General announced that he will appeal the decision to the 9th Circuit Court of Appeals, although the 9th Circuit Court has already ruled against similar bans on same-sex marriage. A decision to seek a stay of the ruling has not yet been determined.
The Governor of Montana, Steve Bullock, supports the freedom to marry.
In his ruling, Judge Morris says regarding same-sex couples:
These families want for their children what all families in Montana want. They want to provide a safe and loving home in which their children have the chance to explore the world in which they live. They want their children to have the chance to discover their place in this world. And they want their children to have the chance to fulfill their highest dreams. These families, like all of us, want their children to adventure into the world without fear of violence; to achieve all that their talent and perseverance allows without fear of discrimination; and to love themselves so that they can love others. No family wants to deprive its precious children of the chance to marry the loves of their lives. Montana no longer can deprive Plaintiffs and other same-sex couples of the chance to marry their loves.
The open enrollment period for individuals purchasing private health insurance has begun once again when the insurance exchanges opened on Saturday. If you like your plan and don’t care about what the cost might be to renew, your policy will automatically renew. If you purchased insurance on the exchanges last year and all you care about is price – then you better go back and shop again.
If you don’t go back on the exchange and shop around, your insurance plan will be automatically renewed on December 15th. On average, the price for the cheapest plan in the most popular category in 2015 will be about 3.4% higher than in 2014. By comparison, prices prior to implementation of the Affordable Care Act were around 10% per year for individual insurance. The reason for the slow increase in prices? Competition among insurers.
But keeping the exact same plan may lead to above that 3.4% threshold – in some cases around 9.7%. Therefore, if price is all you care about, keeping the cheapest, most-popular plan from 2014 may not be the best bet any more. Granted, switching plans is not without hassle – it may mean different deductibles, co-payments, drug benefits, and potentially changing doctors.
Regardless of whether you want to change plans, you should go back to the markeplace and update your information, as changes to household income may affect your subsidy.
The New York Times Upshot column shows rates from the 43 states that have published final prices on either Healthcare.gov or that state’s marketplace site.
Two federal judges made history today by ruling for marriage equality – one in Kansas and one in South Carolina.
U.S. District Judge Richard Gergel issued a ruling in South Carolina, declaring that state’s ban on same-sex marriage unconstitutional. Judge Gergel ruled in favor of Colleen Condon and Ann Bleckley, a same-sex couple who filed a lawsuit against the state when they were denied a marriage license after applying for one and paying the filing fee in early October.
In the ruling, Judge Gergel granted the state’s motion for a temporary stay on issuing gay marriage licenses until Nov. 20. Governor Nikki Haley and Attorney General Alan Wilson are expected to appeal the decision, however the 4th US Circuit Court of Appeals already ruled on similar cases in Virginia, overturning that state’s marriage equality ban.
And today in Kansas, U.S. District Judge Daniel Crabtree ordered Kansas to stop enforcing its discriminatory ban on marriages for same-sex couples. In his decision, Judge Crabtree noted that “Kansas’ same-sex marriage ban does not differ in any meaningful respect from the Utah and Oklahoma laws the Tenth Circuit found unconstitutional.” Crabtree felt that the 10th Circuit Court’s precedent was binding, as Kansas falls under the 10th Circuit Court’s jurisdiction.
The state now has the option to appeal today’s order to the Tenth Circuit, which has already ruled such marriage bans unconstitutional.
Interestingly, Kansas and South Carolina were both holdout states, as the federal Circuit Courts that have jurisdiction of the two states both ruled earlier this year that bans on marriage equality violate the US Constitution. Those rulings were allowed to stand when the Supreme Court of the United States declined to hear the cases on appeal, paving the way for marriage equality to become law in all states within the Tenth and Fourth Circuits.
After the country sobered up following the midterm elections, the courts decided to add fuel back to the fire and decide on some critical marriage equality cases.
The day after the election, a state judge in Missouri overtunred the state’s constitutional ban on same-sex marriage. St. Louis Circuit Judge Rex Burlison said in a written ruling that Missouri’s measure recognizing marriage only between a man and woman violates the due process and equal protection rights of the U.S. Constitution.
Missouri Attorney General Chris Koster immediately appealed the ruling to the Missouri Supreme Court, but he said that his office wouldn’t seek a stay of the order, noting that the U.S. Supreme Court refused to grant stays after same-sex marriage decisions in Idaho and Alaska. The decision not to stay the ruling meant that couples in St Louis County could immediately apply for marriage licenses in the Show Me State.
The ruling ran counter to a remarkably rapid string of victories for the gay rights movement over the past few months that have now made same-sex marriage legal in at least 30 states. More than 20 court victories for supporters of same-sex marriage have been handed down since the Supreme Court struck down part of the federal Defense of Marriage Act last year, including decisions by the 4th, 7th, 9th, and 10th Circuit Courts. Just last month, the Supreme Court surprisingly turned away appeals from five states seeking to uphold their same-sex marriage bans.
The decision by the 6th Circuit Court undoubtedly mounts increased pressure on the Supreme Court to act on the issue of marriage equality. Judge Martha Craig Daughtrey suggested as much in her dissenting opinion, where she blasted her colleagues, saying their majority opinion failed to address the issues of whether a state constitution’s ban on same-sex marriage violates the equal protection clause of the 14th Amendment. Daughtrey wrote:
Instead of recognizing the plaintiffs as persons, suffering actual harm as a result of being denied the right to marry where they reside or the right to have their valid marriages recognized there, my colleagues view the plaintiffs as social activists who have somehow stumbled into federal court, inadvisably, when they should be out campaigning to win ‘the hearts and minds’ of Michigan, Ohio, Kentucky, and Tennessee voters to their cause.
But these plaintiffs are not political zealots trying to push reform on their fellow citizens; they are committed same-sex couples, many of them heading up de facto families, who want to achieve equal status … with their married neighbors, friends, and coworkers, to be accepted as contributing members of their social and religious communities, and to be welcomed as fully legitimate parents at their children’s schools. They seek to do this by virtue of exercising a civil right that most of us take for granted — the right to marry.
She added that it was “ironic that irresponsible, unmarried, opposite-sex couples in the Sixth Circuit who produce unwanted offspring must be ‘channeled’ into marriage and thus rewarded with its many psychological and financial benefits, while same-sex couples who become model parents are punished for their responsible behavior by being denied the right to marry.”
goddamn it, I can’t get in! should we just go back to bed?
As a physician and a public health advocate, you would think I’d have plenty to write about the Ebola outbreak. To be honest, the whole situation has left me rather uninspired, mainly due to the ridiculous hysteria surrounding the disease in the US media. That said, the current outbreak has made some things particularly clear.
- Americans don’t care about events in other parts of the world… until it affects our own borders.
- Americans are terribly uneducated in geography.
- In a battle between science and fear/hysteria, science will always lose.
- Any issue, no matter how apolitical, can be turned into a political weapon… by both parties.
- Our country continues to misfear.
- We expect our health care system to save us in times of crisis despite complaining about it constantly.
- We underestimate the importance of public health (see number 6).
- Only one person in the United States has died from Ebola, and only one person is currently under treatment.
- There have already been deaths from the flu this season, including a child who died this week.