Two justices may decide fate of Obama healthcare law

The justices of the U.S. Supreme Court gather for a group portrait in the East Conference Room at the Supreme Court Building in Washington, October 8, 2010. Seated from left to right in front row are: Associate Justice Clarence Thomas, Associate Justice Antonin Scalia, Chief Justice John G. Roberts, Associate Justice Anthony M. Kennedy, Associate Justice Ruth Bader Ginsburg. Standing from left to right in back row are: Associate Justice Sonia Sotomayor, Associate Justice Stephen Breyer, Associate Justice Samuel Alito Jr., and Associate Justice Elena Kagan.

The legal fate of President Barack Obama's signature healthcare law will likely come down to two Republican appointees on the U.S. Supreme Court -- Chief Justice John Roberts and Justice Anthony Kennedy.

That would be a familiar role for Kennedy, a moderate conservative who often has cast the decisive vote on the most contentious issues before the nine-member high court divided between conservative and liberal factions.

A Supreme Court ruling on the healthcare law, adopted by a Democratic-controlled Congress after a bruising political battle, could be a defining moment for Roberts, who was named chief justice in 2005 by Republican President George W. Bush.

"Given the deep ideological divisions over the case and the lack of precedent clearly on point, the court could easily rule either way," Ilya Somin, associate law professor at George Mason University, wrote in a recent blog post.

U.S. appeals courts have issued conflicting rulings on whether Congress exceeded its power under the Constitution when, in adopting the healthcare law in 2010, it required that Americans buy insurance or face a penalty.

The latest decision, handed down on Friday from an Atlanta-based appeals court, struck down that individual mandate provision, making it more likely the Supreme Court will get involved.

University of Richmond assistant law professor Kevin Walsh said the Supreme Court seemed virtually certain to decide the issue by the end of June next year. That would mean a ruling before the U.S. elections in November 2012, with the law seen as a major political issue.

Obama has championed the individual mandate as a major accomplishment of his presidency and as a way to try to slow the soaring costs of healthcare while expanding coverage to more than 30 million Americans without it.

"If the Supreme Court follows existing precedent, existing law, it should be upheld without a problem," Obama said in Minnesota during a town hall discussion. "If the Supreme Court does not follow existing law and precedent, then we'll have to manage that when it happens."

REPUBLICANS CRITICAL

Republican presidential candidates have strongly criticized the law as costly and evidence of intrusive government power.

Legal experts said the court's four liberals, all appointees of Democratic presidents, were likely to uphold the individual mandate. Justices Stephen Breyer and Ruth Bader Ginsburg were appointed by President Bill Clinton while Obama named Justices Sonia Sotomayor and Elena Kagan.

The experts said Justice Clarence Thomas was expected to vote to strike down the mandate, based on his past opinions, and could be joined by fellow conservatives, Justices Antonin Scalia and Samuel Alito. All three were named by Republican presidents.

That would leave Roberts, a conservative who on occasion has refused to join far-right positions taken by Scalia and Thomas, and Kennedy to control the outcome.

Kevin Russell, a Washington lawyer who argues before the Supreme Court and who has followed the healthcare law, said Kennedy has been one of the justices most protective of state power against federal government encroachment.

"If he views the mandate as invading an area of traditional state authority, I think he may be one of the least likely justices to vote to uphold it," Russell said.

Orin Kerr, a George Washington University law professor, predicted Roberts and Kennedy both would likely end up voting to uphold the individual insurance mandate.

He cited an opinion by Kennedy in 1995 and the expansive view that Roberts recently supported of the power of Congress under the Constitution to adopt laws necessary and proper.

Sources: http://www.reuters.com/article/2011/08/15/us-usa-healthcare-analysis-idUSTRE77E5A820110815

More tests not always needed for diagnosis

An EKG technician performs an electrocardiogram on a patient at a hospital in Houston, Texas, July 27, 2009.

Examining patients and taking a medical history are more useful to hospital doctors in diagnosing patients than high-tech scans, according to a study from Israel.

Tests such as CT scans and ultrasounds add to hospital bills, but doctors said that such tests given right after patients showed up in emergency rooms only helped with diagnosis in roughly one of three cases, the study -- published in the Archives of Internal Medicine -- said.

There is also research showing that the radiation from multiple CT scans might increase the risk of cancer over the long term.

To see whether such scans were really helpful, researchers led by Ami Schattner of Kaplan Medical Center in Rehovot, Israel, followed all the patients who showed up at the emergency room of a teaching hospital and were subsequently admitted.

"Basic clinical skills remain a powerful tool, sufficient for achieving an accurate diagnosis in most cases," Schattner and his colleagues wrote.

"Physicians may count more on their clinical faculties when making decisions about patients."

Over about two months, Schattner and his colleagues observed 442 consecutive patients. Each was separately examined by two doctors, a resident and a senior physician, who also asked patients about past health problems.

Both doctors had access to results from all routine tests, including blood and urine analysis, and any extra scans that had been done when the patient first got to the emergency room.

The researchers later looked at how accurate the clinicians were in their decisions, compared to the final diagnoses patients were given during or after their hospitalization. They also asked the doctors what factors they relied on most when diagnosing each patient.

Both clinicians made the correct diagnosis between 80 and 85 percent of the time.

Only about one in six patients had extra testing -- mostly CT scans, usually of the head -- done in the emergency room. The rest just had simple blood, urine or heart tests.

But even for the patients who did have extra scans, the doctors said the results helped to make a diagnosis only about one-third of the time.

Instead, patient history alone or history plus a physical exam were most important to a doctor's correct diagnosis in almost 60 percent of cases. When basic tests were included, they were the basis of more than 90 percent of correct diagnoses along with the history and exam.

"The doctoring process is still a personal communication between the patient and the clinician," said Matthew Sibbald, a cardiologist at the University of Toronto who wasn't involved in the study.

"As much as we want to... rely on the technology, it's not the technology that helps us make a diagnosis," he told Reuters Health.

Sources: http://www.reuters.com/article/2011/08/15/us-tests-idUSTRE77E0DL20110815

More U.S. kids in hospital for mental illness

American kids are increasingly likely to be admitted to the hospital for mental problems, although rates of non-psychiatric hospitalizations have remained flat, a new study shows.
From 1996 to 2007, the rate of psychiatric hospital discharges rose by more than 80 percent for 5-13-year-olds and by 42 percent for older teens.
"This occurs despite numerous efforts to make outpatient services for the more vulnerable kids more widely available," said Joseph C. Blader of Stony Brook State University of New York, whose findings appear in the Archives of General Psychiatry.
He said hospitalization is the last resort, because it's so disruptive for normal life.
"It's a pretty traumatic thing for a family when your child is admitted to a psych unit," he told Reuters Health.
Overall, short-term hospital admissions for mental illness rose from 156 to 283 per 100,000 children per year over the ten-year study period, based on data from the National Hospital Discharge Survey.
For adolescents, the rate increased from 683 to 969 per 100,000, while it went up from 921 to 996 for adults and dropped from 978 to 808 for people 65 and older.
The change for the elderly was expected, Blader said, because of cuts in Medicare reimbursement for inpatient hospitalizations.
For youngsters, bipolar disorder showed the steepest increase, while anxiety diagnoses dropped.
Although there have been concerns about overdiagnosis of bipolar disorder and other mental problems among children, Blader said that was unlikely to be hiking the rates.
That's because hospitalizations are based on whether or not people are considered a danger to themselves or others, not on psychiatric labels.
"Most typically it's volatile and aggressive behavior, or overreaction to minor provocations that lead to assaults on family members or peers," Blader told Reuters Health.
There was also a decline in the proportion of hospital stays paid for by private insurers. But whether that reflects a growing quality gap in mental health care or is a consequence of increased government coverage is unclear.
"There is no way these kinds of data are going give you the answers on a silver platter," Blader said.
He believes the rate hikes are real and alarming and says now is the time to study the underlying reasons.
"Whereas before we had hoped that more outpatient services would lead to a decrease in hospitalizations, the findings suggest a pressing need to learn what might have reversed that trend," Blader said.

Sources : http://www.reuters.com/article/2011/08/03/us-kids-mental-illness-idUSTRE7726UY20110803