Case Analysis Essay Example | Topics and Well Written Essays - 250 words - 5

Case Analysis - Essay Example In relation to the case of Tratelemonioc, the appropriate remedy in response to the violation of NLRA is that the management should highly emphasize the participation of employees in terms of selecting issues committees or the members as well (National Labor Relations Board, 2014). The violation of NLRA does not mean reformation of the labor law in order to emphasize employee participation. In this case, adequate compliance with the NLRA policies and provisions regarding the formation of issues committees can lower the risk for the employees working in Tratelemonioc (National Labor Relations Board, 2014). With reference to an understanding of the case, the decision of the district court can be duly agreed in accordance with the overtime-pay requirement provisions in the Fair Labor Standards Act (FLSA) of 1938 (Chamberlain, Kaufman and Jones, 2003). In relation to the policies of FLSA 1938, few occupations are exempted from the overtime pay with the purpose maintaining fair and equal pay distribution in response to the workload in the organization (Chamberlain, Kaufman and Jones, 2003). The most suitable ethical resolution to address the dilemma regarding the exemption from over-time pay in specific job profiles would be a process of compensating this particular group of employees. Providing reward for continuous contribution for working overtime can also be an effective ethical practice for the organization (United States Courts for the Ninth Circuit,

Linguistics worksheet Lab Report Example | Topics and Well Written Essays - 500 words

Linguistics worksheet - Lab Report Example Being brown eyed can be considered as a reason for believing in UFOs only if non brown eyed people are interviewed and none of them are found to believe in UFOs. b) This again does not prove the theory. It will just show that non brown-eyed people do not believe in UFOs. This does not define the reason of their disbelief nor does it show any connection between believing in UFOs and having brown eyes. a) We can take 10 people; 5 of whom drink coffee while studying and 5 who do not. An assignment will be given to all of them where they have to memorize words, facts or small poems over a period say 3 days. After three days, everyone is given an assignment which should contain few question to quote the learned things and few would be questions which to be answered, need the information they learnt in past 3 days. f) No, because individual memorizing capacity is inherent and can only sometimes depend on genetic conditions. Also, work environment does not change for people who take caffeine and who do not. It affects everyone similarly.

Ethical Health Care Issues Essay Example for Free

Ethical Health Care Issues Essay According to Women’s Health Resource (2011) â€Å"breast cancer is a serious issue that will affect almost every women worldwide, either directly as someone diagnosed with cancer, or indirectly through the illness of a loved one†( Home, para. 1). In the United States breast cancer is the found in women in their early twenties and thirties. These individuals are more prone to breast cancer because she has a family history of breast cancer. In 2006, approximately 212, 920 new cases of invasive breast cancer were diagnosed in the United States (Women’s Health Resource, 2011). The case scenario below will discuss ethical and legal issues regarding a female patient with breast cancer, which refuses treatment for breast cancer. Additionally, the scenario will cover the following four ethical principles: respect for persons/autonomy, justice, beneficence, and non-maleficence that relates to the case scenario (Bishop, 2003). Case Scenario A 25-year-old female patient made an appointment with her primary care physician because she discovered a lump on her breast. She went to her appointment with her primary care physician the following day. The physician examined her breast and discovered a lump on her breast, so he made a referral for her to see an oncologist in which can diagnose her if she has breast cancer. An oncologist is a medical doctor who specializes in the diagnoses and treatment cancer (The Denise Roberts Breast Cancer Foundation, 2009). The following are the three main types of oncologist: medical oncologist, radiation oncologist, and surgical oncologist, which can practice in hospitals and research centers. The female patient can make an appointment with the oncologist in which he will inform about her condition and different types of treatments available to her in which can reduce her chance of death as well conduct a biopsy. The biopsy will determine if she has breast cancer. The ethical issues are very clear, and they are respect for autonomy and beneficence. Additionally, the legal or ethical principles involved with breast cancer are no different from any other medical  treatment/intervention. Autonomy and Informed Consent As stated by Bishop (2003), â€Å"respect for persons/autonomy is that a physician acknowledges a person’s right to make choices, to hold views, and take actions based on personal values, and beliefs† (p. 7). In order for an adult to refuse treatment, he or she must be legally and mentally capable by meeting the following criteria: 18 years or older, understands the nature of the condition, and voluntary. Additionally, parents with children under the age of 18 have the right to consent to treatment as well refusing treatment for his or her child. As recognized by Miller et al. (2000), physicians have a moral and legal obligation to comply with a patient’s voluntary, informed refusal of life sustaining treatment, regardless of a physician judgment concerning the medical or moral appropriateness of this. In the case of the 25-year-old female patient with breast cancer she rejected medical treatment and was informed by the oncologist about the terminal illness. Death is seen as failure, rather than an important part of life (Smith, 2000). A conflict can arise with the patient because of the decision she made about not receiving care, which can likely end her life. The oncologist is obligated to inform or educate the patient about breast cancer, benefits of treatments, and risks involved with no treatment. The following are treatment options for cancer patients: lumpectomy, mastectomy, chemotherapy, radiation therapy, and surgical reconstruction (Women’s Health Resource, 2011). Although a physician can suggest benefits of any type of treatment the patient has the freedom to choose if he or she wants the treatment as well as ensuring the patient understand his or her own condition. When a patient refuses treatment for breast cancer or any medical condition, the issue of autonomy becomes difficult because of the serious health consequences. The health care professional will offer the patient different options for treatment when this occurs. As stated before the physician should consult with the patient about his or her decision because nurses have ethics and codes of conduct in which he or she must follow. Nurses must care for patients while taking care of him or her as  well as respecting and supporting the patient rights to decline treatment at anytime (Stringer, 2009). Medical professionals should respect the autonomy of patient decisions because it is a critical in the health care industry. Beneficence Rosenthal (2006), the principle of beneficence means that the health care provider must promote the well-being of patients and avoid harm them. Once a patient refuses treatment the health care professional must communicate the harm associated with no treatment for his or her condition. This can play a major role in how beneficence and maleficence is judged. When a patient has breast cancer and refuses treatment there is not another alternative option for the patient. During this principle the health care professional should ensure that he or she is maximizing possible benefits for the patients and minimizing harm when dealing with treatments. The health care professional can suggest certain treatments but the patient does not have to receive any care for his or her condition. When this occurs the physician will focus on different conflict resolutions for the care as well as services. A health care professional job is to offer quality of care to the patient in which he or she will ben efit from the medical treatment. During this principle, the health care professional will act with compassion when informing the patient about the potential benefits and risks for any medical condition. A patient is reliant upon the health care professional for someone who is caring and willing to share in the responsibility as well as treating him or her with dignity and respect. The 25-year-old female does not want treatment in which makes it hard for the oncologist to provide quality of care during the consultation and care. Non-maleficence Rosenthal (2006), during this principle, the health care provider ought to strive not to inflict harm to a patient, a requirement also seen as a duty not to refrain from aiding a patient. In addition, this principle will coincide with beneficence because it is reducing the harm to any patient  although a patient refuses care/treatment. The health care professional is obligated to help the patients to the best of his or her ability by providing benefits, protecting the patient’s interest, and promoting welfare. Additionally, how, and what the health care professional does for a patient should have greater chance of benefiting the patient than harming the patient. This is done by risk benefit analyses, where the health care professional can conduct research on the condition and different medications. The health care professional should explain any side effects for treatments as well as medications that the patient will become knowledgeable about options for his or her conditio n. Justice The principle of justice means to treat others equitably, distribute benefits/burdens fairly (Bishop, 2003). In addition, it is very important for the health care professional to keep a patient informed about treatments and he or she should not provide misinformation to the patient. A major issue with this principle is economic barriers can interfere with a patient when trying to receive treatment and medication. The health care organization is required to provide services/care to a patient regardless of health care coverage, especially the uninsured In addition, the department should that all patients are treated equally regardless of age, race, and ethnicity. Additionally, this principle will focus on justice, which will provide care/treatment regardless of the patient demographics or ethical issues he or she encounters with the health care professional. During this principle, the patient is treated with dignity and respect even though he or she refused care/treatment for any medic al condition. Conclusion Refusal of care is one of the most common ethical dilemmas in the health care industry, which is often difficult to resolve when his or her well-being is threaten. The health care professional must determine, which aspects of autonomy, beneficence, justice, and non-maleficence a patient want before providing care. Administrators within a medical facility must  examine the following underlying issues: competence of a patient, the distinction between apparent, and real refusal of care (Michels, 1981). A physician has the legal duty to provide and ensure the patient with sufficient information about treatment and care when he or she is at the facility. Additionally, an ethical dilemma will exist because of a patient’s right will conflict with a physician obligation of providing quality of care to an individual. This was the case with the 25-year-old female with breast cancer. References Bishop, L. (2003). Ethics Background. Kennedy Institute of Ethics. Retrieved on June 8, 2011 from: http://www.nwabr.org/education/pdfs/PRIMER/Background.pdf Michels, R. (1981). The Right to Refuse Treatment: Ethical Issues. American Psychiatric Association, 32(1), 251-255. Miller, F., Fins, J., Snyder, L. (2000). Assisted suicide compared with refusal of treatment: a valid distinction?.Annals of Internal Medicine, 132(6), 470-475. Rosenthal, S. M. (2006). Patient Misconceptions and Ethical Challenges in Radioactive Iodine Scanning and Therapy. Journal if Nuclear Medicine Technology, 34( 3), 143-150. Smith, R. (2000). A good death: an important aim for health services and for us all. . British Medical Journal, 320(7228), 129-130. Stringer, S. (2009). Ethical issues involved in patient refusal of life-saving treatment. Cancer Nursing Practice, 8(3), 30-33. The Denise Roberts Breast Cancer Foundation . (2009). What is an Oncologist? Retrieved June 17, 2011 from http://www.tdrbcf.org/oncologist/index.html Womens Health Resource. (2011). Breast Cancer. Retrieved on June 17, 2011 from http://www.wdxcyber.com/breast_home.html

African Slave Trade and West African Underdevelopment

African Slave Trade and West African Underdevelopment This paper looks at whether the Atlantic slave trade contributed to the underdevelopment of West Africa. The paper argues that the issue of African underdevelopment is extremely complex, including many factors, aside from the Atlantic slave trade, that have contributed, and continue to contribute, to the underdevelopment of Africa. The paper begins with a review of the slave trade, in terms of the numbers of people involved in this, and the immediate effects of this trade on local economies. The effects of this trade on importing economies is then reviewed, and it is shown that many importing countries benefited massively from this trade, through increased labour supply and through monetary gains which were then applied to developing industry in the importing countries. The repercussions of this industrial development are then discussed, in terms of its effects on Africa. The paper then moves on to look at the effect of the slave trade on Africa, in terms of the demographic imbalances this caused, and the effects this had on the development of African countries, in terms of social, political and economic development. The paper then moves on to look at the roles, and effects, of the colonial powers on African countries, in terms of exploitation of Africa’s natural resources and the immediate and long-lasting effects this has had on Africa, and the continuing exploitation of Africa, through development loans, for example, which cripple the economies of many African countries, through the massive interest payments required, which leaves little money for investment to develop local industry, or social projects. The paper thus sees African underdevelopment as a holistic problem, involving far more than the slave trade, and having far-reaching implications for future generations of Africans. In addition to looking at the effects of the slave trade on African underdevelopment, the term ‘underdevelopment’ will be discussed in an African context. As will be seen, Rodney (1972) argues, in his book How Europe Underdeveloped Africa, that there is no such thing as ‘underdevelopment’, that underdevelopment is not an absence of development, rather that it can only be understood in the context of comparisons, of ‘more developed’ with ‘less developed’ nations, for example, and that it is best understood in the context of exploitation, as, for Rodney, most currently underdeveloped countries are also the countries that are exploited by others, through capitalist, imperialist or colonialist means (Rodney, 1972; p. 110-112). The paper will conclude that capitalist exploitation of Africa began with the slave trade and continues to the present day and is, as we have see, the major factor that was, and continues to be, responsible for th e comparative underdevelopment of African nations. As we have argued, the slave trade per se did not contribute to the comparative underdevelopment of Africa, rather a complex mixture of exploitation, lack of opportunity, and capitalist interests contributed to the underdevelopment of Africa. It is estimated by Curtin (1969) that 9,566,100 slaves were exported from Africa to the Americas and other parts of the Atlantic basin, from it’s beginning in 1451 to when this trade ended in 1870. Many subsequent researchers have, however, provided evidence which shows that this figure is an under-estimation; for example, Stein (1978) has presented a figure some twenty per cent higher than Curtin’s (1969) estimation and Lovejoy (1982) used new calculations, and new shipping data, to put the figure at some 11,698,000. Whatever the exact figure, however, it is clear that demographically, this trade had a massive impact on West Africa, with Thornton (1980) showing that there are marked differences in economic, demographic, political and social development between slave-depleted areas, slave-importing areas and slave-trading areas. The debate that subsequently surrounded Curtin’s estimation of the number of people involved in the Atlantic slave trade has therefore i nvolved much more than a disagreement about numbers: it rests more, now, on whether the slave trade was actually a contributing factor in the current underdevelopment of West Africa. This paper expands the ideas presented by Curtin (1969), and Thornton (1980), looking at the social, economic and political effects of the slave trade on Africa. Rodney (1972; p9-10) argues very strongly that development is characterised by growth in economic production, equity in the distribution of social product and autonomy in control over social processes, and that, as such, underdevelopment is not a state that can be overcome as ‘backward’ societies move through the same stages of growth as ‘advances’ societies, as, instead, Rodney sees capitalist development and underdevelopment as two sides of the same coin (Legassick, 1976). Rodney argues strongly, throughout his book, for African capability, but argues that deeply rooted, externally imposed structural constraints prevented, and prevents, the further development of African society[1]; for example, he argues that what he terms the ‘determinative power’ of the colonial state was one factor that contributed to the underdevelopment of West Africa, not necessarily, therefore, that it was the slave trade per se that contributed wholly to the underdeve lopment of West Africa; this argument is somewhat supported by Brett (1973), who argues strongly throughout his book that the colonial state presence prevented industrialisation in the East African countries he studied, arguing that resource allocation led to peasant agricultural systems becoming the dominant form of agriculture in these countries, for example. It is interesting, then, that both these authors see colonial rule (i.e., political structure) as being the dominant force shaping underdevelopment in Africa, with Brett (1973) arguing that this was the sole factor important in shaping underdevelopment, and Rodney (1972) arguing that colonial rule was but one factor shaping underdevelopment in Africa, in concert with, for example, the demographic skews caused by the slave trade. As such, as Brett (1973) and Rodney (1972) argue, the presence of a colonial power in Africa prevented the development of political structures which would have been conducive to a coherent and holistic development of an industrialised society in Africa; without a political structure which supported assessments of the international economy, from an African perspective, and without political power with an African interest, Africa was left high and dry, unable to develop on African terms, and left at the mercy of the colonial political power, who made decisions based on their own interests, not decisions that were best, in the short or long term, for Africa. The presence of the colonial power thus, itself, led to the underdevelopment of Africa, politically, which had, and continues to have (as we shall see) massive repercussions for African society, in terms of its economic and social development. This academic argument over the numbers of slaves involved in the slave trade shadows the massive scale of the problem: slaves were preferred to be between the ages of fifteen and thirty five, and more men were taken than women, at a ratio of 2:1, skewing the demographics of the towns and villages from where the slaves were taken (Rodney, 1972). As we have seen, 9,566,100 slaves were exported from Africa to the Americas and other parts of the Atlantic basin, from it’s beginning in 1451 to when this trade ended in 1870. Many subsequent researchers have, however, provided evidence which shows that this figure is an under-estimation; for example, Stein (1978) has presented a figure some twenty per cent higher than Curtin’s (1969) estimation and Lovejoy (1982) used new calculations, and new shipping data, to put the figure at some 11,698,000. Whatever the number of slaves that were exported, however, the slave trade essentially extracted all of the healthy men, of reproductive age from African countries involved in the slave trade: this, essentially, led to a lack of a suitable workforce with which to forge ahead with agricultural, social or technological developments, leading to a lack of internal development within Africa, which, couple with the import of cheap goods in to Africa from industrialising nations (i.e., the colonial powers) led to the death of the African manufacturing industry. This, coupled with the lack of a coherent African political power with a presence, and an influence in the region, led directly to the underdevelopment of African countries. In essence, due to the slave trade and the presence of the colonial power, Africa (African leaders) never had a chance to assess itself and to make decisions as to how to go forward and develop political, economic or social structures that would have led to econo mic success. This alone has contributed to the lag in development of Africa, if, indeed it is a lag, if Africa can ever come out of the underdeveloped state it is in, which is a moot point, and which many argue can never happen. This, in conjunction with the massive exploitation of Africa’s natural resources, such as oil, diamonds, bauxite, copper, by external companies (owned by individuals based within the colonial powers) seeking to make a profit from these resources has, many argue, doomed Africa to perpetual underdevelopment. This, in conjunction with ‘aid’ loans given by the World Bank, for example, which have left the economies of African countries in massive debt, with the interest, alone, crippling the economies of these countries, has, again, left Africa in a situation from which it is difficult to see a recovery, let alone a move towards any form of meaningful economic development. The raping of Africa: it’s people, it’s resources, it’s opportun ities, is therefore something that has been present throughout it’s history and which continues to the present day. Thus, not only did the Atlantic slave trade contribute to the underdevelopment of Africa, through the many routes that have already been discussed, but the colonial presence in Africa which led to the raping of Africa’s natural resources, and the domination of these natural resources by external, foreign, companies, has led directly to underdevelopment. These resources were not available for exploitation by Africans, and so Africans were not able to profit from these resources, and were not able to invest these profits in growing industry or technological developments. As such, many scholars argue, Africa was, by the very fact of the raping of its natural resources, doomed to underdevelopment. This coupled with crippling levels of debt that have been incurred through ‘developmental aid’ loans with unfairly high levels of interest, from previous colonial powers, has led to the continued underdevelopment of many African countries. Current campaigns to ‘drop th e debt’ in many African countries may, it has to be said, have come far too late to have much effect, especially when one considers the other, more deadly, scourge which is altering African demographics today: HIV, which, it is estimated, culls more of the African population in many African countries than was ever taken by the slave trade. This new demographic threat is even more deadly considering that drugs are available to treat the disease caused by this virus, but that the current colonial powers, and the companies that are protected by laws of these colonial powers, do not allow these drugs to be sold at a reasonable cost to Africa, essentially blocking off a route to treatment, and condemning a whole generation of Africans to death, and through this, condemning Africa to decades, if not centuries, of continued underdevelopment. In light of this historic pattern of the raping of Africa, perhaps the question should not be how did the slave trade contribute to Africa’s underdevelopment, but, rather, how did the imported slaves contribute to the rapid development of the host countries. For example, African slaves were used in gold and silver mining in the Americas, and certainly speeded up Europe’s technological development, with, for example, English ports involved in the slave trade, such as Liverpool, growing economically with the importing of slaves, and then this economic growth fuelling development in this region which, ultimately, led to the Industrial Revolution. Other specific examples from an English context include individuals who became wealthy through dealing in the slave trade who then used this money to set up successful firms; the Barclays, for example, used money earned from the slave trade to set up Barclays Bank, and Lloyds coffee house expanded in to Lloyds banking and insuranc e following involvement in the slave trade. James Watt, of steam engine fame, also accepted money from slave traders to fund the development of his steam engine; without the slave trade, therefore, many technological developments in Europe, particularly England, would not have happened, and Europe, the world, would not be so well-developed. Imagine a world without the Industrial Revolution: it would, ironically, perhaps look something like Africa looks today. This simplistic analysis of the effects of the importing of slaves is just that: simplistic, but it shows, in rough terms, how the slave trade contributed to economic development and societal progress in the importing countries. This, then, fuelled the rise, the development, of these societies, at the expense of the exporting countries, fuelling longer and stricter periods of colonial rule in the exporting countries, and causing yet more underdevelopment in these countries. This process, in concert with massive demographic depletions, which left, realistically, no workforce in some regions of West Africa, contributed to the underdevelopment of these societies, economically, socially and politically, as, we have seen, is argued by Brett (1973) and Rodney (1972)[2]. In addition, as many current scholars argue, it was, perhaps is, the inability of African societies to come to terms with the consequences of the slave trade that has also held the development of Africa back in realistic terms. For example, many of the African slaves were actually sold to Europeans by Africans themselves, either African leaders or traders, who often conducted raids to collect (i.e., kidnap) suitable subjects for sale in to slavery. Some of these African slave traders became very rich on the profits of their trade, but, unlike in Europe, as we have seen, these traders did not invest their profits in African society or in technological developments; they simply used the money for personal gain and personal interests. The interests of African slave traders in the slave trade, and their reliance on this trade, was shown to be extremely strong following the discussions to abolish this trade; much of the opposition to abolition was from African slave traders themselves, wh o were worried that they would lose out on a massive source of income. Indeed, many did lose income from the Atlantic slave trade and then turned to internal slave trading as a means of generating income. Thus, the slave trade, whilst lessening in volume, did not cease entirely in many African countries, and continued to contribute to a disruption of local societies and to a lack of holistic development of social, political and economic forces within many African societies, in which the slave traders (often rulers, as we have seen) began to act, to take the role of, the colonial power, forging similar patterns of underdevelopment to those described by Brett (1973) for colonial powers in Africa. In addition, much of the profit from the slave trade made by African slave traders was not invested in infrastructure or social projects, or in planning for development through technological improvements; most of the profits, as we have seen, were invested in arms for warfare or in consumer goods. This flood of consumer goods, produced outside of Africa, in Europe for example, had the effect of destroying the few local industries there were, with the long-term effect of destroying many of the manufacturing industries in Africa and, as such, denying Africans the basic conditions for economic growth. The slave trade did not encourage African societies to enter in to the international economy in a positive way, rather it encouraged Western economic development, through, as we have seen, providing a source of labour and income, and by providing markets for some of the new products that were being produced by the Industrial Revolution. This paper will conclude, therefore, that the Atlantic slave trade did not per se cause underdevelopment in Africa, rather that the slave trade is but one piece of a complicated jigsaw of effects that, as a whole, forced Africa in to underdevelopment. The slave trade did take massive numbers of young males out of Africa, thus causing severe depletions in the African workforce, and meaning that the African population growth was curtailed for many years, through lack of breeding, for example[3]. In addition, the import of a workforce in to Europe caused inflations in the local economies at the importing ports, which had cascade effects on the local areas; the slave trade also meant that many individuals became rich, and were able to fund technological developments, which helped to fuel, in part, the Industrial Revolution, for example. This meant that the colonial powers could govern more effectively and for a more prolonged period; meaning that political and social systems of control w ere not developed internally within the African slave-importing countries, this itself fuelling years of political and social underdevelopment. Thus, many factors, not just the slave trade per se contributed to the underdevelopment of West Africa. A statement such as â€Å"the Atlantic slave trade contributed to the underdevelopment of West Africa† is far too simplistic to describe the whole cascade of effects that were, have been, and continue to be important in the underdevelopment of West Africa. James Baldwin’s statement, â€Å"The past is what makes the present coherent, and the past will remain horribly incoherent for as long as we refuse to assess it honestly† is particularly apt for the current discussion of this issue. Scholars of different persuasions (whites vs. blacks, Marxists vs. non-Marxists etc) all have their own interpretations of this period of African history, but it is the responsibility of all mankind to assess this situation responsibly, to acknowledge the continued underdevelopment of Africa as a global, moral, responsibility of all humankind, and not to distort the past and use it to cause continued repression and underdevelopment of this continent. Recent plans, and recent events, for example, leading to the privatisation of water in many African countries is, for example, nothing more than a repeat of colonialism in Africa, a repeat of the raping of Africa, with foreign firms entering in to African economies and destroying them: water privatisation has been shown, for example, to devastate local economies, through ground-up failures in local businesses who can no longer afford to use water. That this has been allowed to happen is a travesty, an insult to Africa, and to all underdeveloped nations; it is a continuation of the exploitation of Africa, its people and its resources, that began at the time of the inception of the slave trade and which continues until the present day. It should ideally be that governments learn from their mistakes through analysis of historical records, not that these mistakes are hidden and repeated in future. As Brett (1973) and Rodney (1972) argue strongly, however, money talks more than moral resp onsibilities, and capitalism will always have two sides: one side that wins and another that loses, facing underdevelopment and poverty as a consequence of losing this battle. As we have seen, this paper has looked at whether the Atlantic slave trade contributed to the underdevelopment of West Africa. The paper has argued that the issue of African underdevelopment is extremely complex, including many factors, aside from the Atlantic slave trade, that have contributed, and continue to contribute, to the underdevelopment of Africa. The paper began with a review of the slave trade, in terms of the numbers of people involved in this, and the immediate effects of this trade on local economies. The effects of this trade on importing economies was then reviewed, and it was shown that many importing countries benefited massively from this trade, through increased labour supply and through monetary gains which were then applied to developing industry in the importing countries[4]. The repercussions of this industrial development were then discussed, in terms of its effects on Africa, showing that local industry was destroyed as a result of cheap imports of textiles, for example, following the manufacturing of this in England following the Industrial Revolution. The paper then moved on to look at the effect of the slave trade on Africa, in terms of the demographic imbalances this caused, and the effects this had on the development of African countries, in terms of social, political and economic development. It was shown that African economic development was held back directly, due to the lack of a workforce and the decline in population growth in Africa over the period the slave trade was active. The paper then moved on to look at the roles, and effects, of the colonial powers on African countries, in terms of exploitation of Africa’s natural resources and the immediate and long-lasting effects this has had on Africa, and the continuing exploitation of Africa, through development loans, for example, which cripple the economies of many African countries, through the massive interest payments required, which leaves little money for investment to develop local industry, or social projects. The paper thus concludes that African underdevelopment as a holistic problem, involving far more than the slave trade, and having far-reaching implications for future generations of Africans. The future is bleak for Africa, and it should be the responsibility of all mankind to act to improve the chances, the opportunities for, all African children, so that the cycle of underdevelopment is not repeated in future. Whether this will happen, however, is dependent on governments, who are run on capitalist principles, and as history has shown us, capitalist, whilst having its shining glories also has a very dark side, which is, essentially, underdevelopment. As we have seen, in light of this historic pattern of the raping of Africa, perhaps the question should not be how did the slave trade contribute to Africa’s underdevelopment, but, rather, how did the imported slaves contribute to the rapid development of the host countries. African slaves were used in gold and silver mining in the Americas, harvesting gold and silver, which was then used to develop these countries. Slavery also certainly speeded up Europe’s technological development, with, for example, English ports involved in the slave trade, such as Liverpool, growing economically with the importing of slaves, and then this economic growth fuelling development in this region, which, ultimately, led to the Industrial Revolution. The Industrial Revolution led the world in to industrialisation, or rather, those sections of the world which had political, economic and social systems in place to realise the implications of the Industrial Revolution and to jump on board of it before they got left behind and exploited. As we have seen, other specific examples from an English context include individuals who became wealthy through dealing in the slave trade who then used this money to set up successful firms; the Barclays, for example, used money earned from the slave trade to set up Barclays Bank, and Lloyds coffee house expanded in to Lloyds banking and insurance following involvement in the slave trade. James Watt, of steam engine fame, also accepted money from slave traders to fund the development of his steam engine; without the slave trade, therefore, many technological developments in Europe, particularly England, would not have happened, and Europe, the world, would not be so well-developed. Thus, there is a direct line linking the slave trade with industrial development in the industrial world. Imagine a world without the Industrial Revolution: it would, ironically, perhaps look something like Africa looks today. That Africa was not part of this development, despite the fact that Africans he lped fuel this development is a cruelly ironic historical fact. This simplistic analysis of the effects of the importing of slaves is just that: simplistic, but it shows, in rough terms, how the slave trade contributed to economic development and societal progress in the importing countries. This, then, fuelled the rise, the development, of these societies, at the expense of the exporting countries, fuelling longer and stricter periods of colonial rule in the exporting countries, and causing yet more underdevelopment in these countries. This process, in concert with massive demographic depletions, which left, realistically, no workforce in some regions of West Africa, contributed to the underdevelopment of these societies, economically, socially and politically, as, we have seen, is argued by Brett (1973) and Rodney (1972). As we have seen, this paper thus concludes that African underdevelopment is a holistic problem, involving far more than the slave trade, and having far-reaching implications for future generations of Africans[5]. The future is bleak for Africa, and it should be the responsibility of all mankind to act to improve the chances, the opportunities for, all African children, so that the cycle of underdevelopment is not repeated in future. Whether this will happen, however, is dependent on governments, who are run on capitalist principles, and as history has shown us, capitalist, whilst having its shining glories also has a very dark side, which is, essentially, underdevelopment. As we have seen, Rodney argues that there is no such thing as ‘underdevelopment’, that underdevelopment is not an absence of development, rather that it can only be understood in the context of comparisons, of ‘more developed’ with ‘less developed’ nations, for example, and that it is best understood in the context of exploitation, as, for Rodney, most currently underdeveloped countries are also the countries that are exploited by others, through capitalist, imperialist or colonialist means (Rodney, 1972; p. 110-112). Capitalist exploitation of Africa began with the slave trade and continues to the present day and is, as we have see, the major factor that was, and continues to be, responsible for the comparative underdevelopment of African nations. As we have argued, the slave trade per se did not contribute to the comparative underdevelopment of Africa, rather a complex mixture of exploitation, lack of opportunity, and capitalist interests contributed to the underdevelopment of Africa. That this can be allowed to continue in to the present day is a blight on the whole of mankind, on everyone who allows this to happen, and on everyone who stands by whilst it happens. In this day and age, when children of eight years old have mobile phones and laptop computers in the ‘developed’ world, it is a travesty that many Africans are having to pay for their water, that many Africans die of AIDS because drug companies refuse to sell drugs to Africa at a reasonable cost, that the legacy of colonialism is still alive in Africa, causing continued suffering, death and exploitation. Africa, romantic, beautiful Africa, of sunsets and safaris, is more than that: it is a rich country, with strong cultures, the birthplace of mankind, and, as such, it deserves more than continued exploitation. Why should an African child’s life be worth less than an English child’s life? In this day and age this modern form of slavery, i.e., lack of opportunity, is as harmful as previous forms of slavery, if not more harmful, and is little more than a repeat of previous forms of slavery, in terms of condemning Africans to a life of misery whilst, all around, everyone else enjoys the benefits of development. Bibliography Brett, E.A., 1973. Colonialism and underdevelopment in East Africa: the politics of economic change. London: Heinemann Educational Books. Curtin, P.D., 1969. The Atlantic slave trade: a census. Madison: Wisconsin. Henige, D., 1986. Measuring the immeasurable: the Atlantic slave trade, West African population and the Pyrrhonian Critic. The Journal of African History 27(2), pp.295-313. Legassick, M., 1976. Review article: perspectives on African development. Journal of African History 17(3), pp.435-440. Lovejoy, P.E., 1982. The volume of the Atlantic slave trade. The Journal of African History 23(4), pp.473-501. Rodney, W., 1972. How Europe Underdeveloped Africa. London: Bogle-L’Ouverture Publications. Stein, R., 1978. Measuring the French slave trade 1713-1792/3. Journal of African history 19(4), pp.515-521. Thornton, J., 1980. The slave trade in eighteenth century Angola: effects on demographic structures. Canadian Journal of African Studies 14(3), pp.417-427. 1 Footnotes [1] In the same vein, Rodney argues that there is no such thing as ‘underdevelopment’, that underdevelopment is not an absence of development, rather that it can only be understood in the context of comparisons, of ‘more developed’ with ‘less developed’ nations, for example, and that it is best understood in the context of exploitation, as, for Rodney, most currently underdeveloped countries are also the countries that are exploited by others, through capitalist, imperialist or colonialist means (Rodney, 1972; p. 110-112). [2] As has been argued, the slave trade essentially extracted all of the healthy men, of reproductive age from African countries involved in the slave trade: this, essentially, led to a lack of a suitable workforce with which to forge ahead with agricultural, social or technological developments, leading to a lack of internal development within Africa, which, couple with the import of cheap goods in to Africa from industrialising nations (i.e., the colonial powers) led to the death of the African manufacturing industry. This, coupled with the lack of a coherent African political power with a presence, and an influence in the region, led directly to the underdevelopment of African countries. In essence, due to the slave trade and the presence of the colonial power, Africa (African leaders) never had a chance to assess itself and to make decisions as to how to go forward and develop political, economic or social structures that would have led to economic success. [3] Rodney, for example, in his book How Europe Underdeveloped Africa shows that whilst the population of Europe quadrupled over the period when the slave trade was functioning, the population of Africa grew by only twenty per cent. [4] For example, we have seen specific examples from an English context, including individuals who became wealthy through dealing in the slave trade who then used this money to set up successful firms; the Barclays, for example, used money earned from the slave trade to set up Barclays Bank, and Lloyds coffee house expanded in to Lloyds banking and insurance following involvement in the slave trade. We have also seen how James Watt, of steam en

Essay --

General Information Deoxyribonucleic acid (DNA) which is found in all living thing and one of the building blocks of the body. (1, 2, 3) The molecule is found in the nucleus of the cell and it is a double helix molecule and it looks like a twisted ladder. If it was unwound the molecule would be 6 feet in length! (2) DNA has 3 nucleotides which are sugar, base, and phosphate. (1) The four bases, which are adenine (A), thymine (T), cytosine(C), and guanine (G) and they are all Nitrogen bases and there are about 3 billion of them.(1, 2, 3, 4) Adenine and thymine always pair up with one another and cytosine and guanine always pair together. (1, 2, 3, 4) In the cell there is also the RNA which acts as the messenger for the DNA because the DNA is too big to leave the nucleus. (1) RNA also doesn’t have thymine, instead it has uracil. (1, 2, 3, 4) The RNA then goes off to tell the ribosomes to make protein for parts of your body that need it the most. (1) Genes are the heredity material that is made up by DNA. (1, 2, 3) Your genes are all have from your mother and half from your father. (2) All of your genes are inside chromosomes which carry your genes. (2, 3, 4) The chromosomes carry thousands of your genes and your DNA will replicate your genes so it stays the same. (1, 2, 3, 4) If the gene code is changed it will cause a mutation. Some mutations can be good like evolution, but some can cause cancer. (1, 2, 3, 4) The 4 different types of mutation are point, frame shift, deletion, and insertion. (1, 2, 3, 4) Point and Frame shift are not as bad because it’s just changing a letter in a sequence but, insertion and deletion are changing the whole sequence. (1) Chromosomes are the tightly packed strands in the DNA which hold all... ...es. Advancement engineering is a newer field but it’s very dangerous because you are advancing the genes beyond their level. Also, advancement engineering has not been successful without any fatal diseases in the future. So we have to ask ourselves is it right to mess with these things. Conclusion The main goal for the H.G.P. was to figure out the complete puzzle of human genome for further study. If you think about it, the Human Genome Project could make people rethink life itself because there is so much technology today that is being used for medical purposes. But you have to think of this new field of science is like opening Pandora’s Box because we don’t know if there are side effects to these treatments and ideas. In conclusion, the Human Genome Project is the start of amazing new ideas to cure cancer or rare diseases, but is it right to mess with life? Essay -- General Information Deoxyribonucleic acid (DNA) which is found in all living thing and one of the building blocks of the body. (1, 2, 3) The molecule is found in the nucleus of the cell and it is a double helix molecule and it looks like a twisted ladder. If it was unwound the molecule would be 6 feet in length! (2) DNA has 3 nucleotides which are sugar, base, and phosphate. (1) The four bases, which are adenine (A), thymine (T), cytosine(C), and guanine (G) and they are all Nitrogen bases and there are about 3 billion of them.(1, 2, 3, 4) Adenine and thymine always pair up with one another and cytosine and guanine always pair together. (1, 2, 3, 4) In the cell there is also the RNA which acts as the messenger for the DNA because the DNA is too big to leave the nucleus. (1) RNA also doesn’t have thymine, instead it has uracil. (1, 2, 3, 4) The RNA then goes off to tell the ribosomes to make protein for parts of your body that need it the most. (1) Genes are the heredity material that is made up by DNA. (1, 2, 3) Your genes are all have from your mother and half from your father. (2) All of your genes are inside chromosomes which carry your genes. (2, 3, 4) The chromosomes carry thousands of your genes and your DNA will replicate your genes so it stays the same. (1, 2, 3, 4) If the gene code is changed it will cause a mutation. Some mutations can be good like evolution, but some can cause cancer. (1, 2, 3, 4) The 4 different types of mutation are point, frame shift, deletion, and insertion. (1, 2, 3, 4) Point and Frame shift are not as bad because it’s just changing a letter in a sequence but, insertion and deletion are changing the whole sequence. (1) Chromosomes are the tightly packed strands in the DNA which hold all... ...es. Advancement engineering is a newer field but it’s very dangerous because you are advancing the genes beyond their level. Also, advancement engineering has not been successful without any fatal diseases in the future. So we have to ask ourselves is it right to mess with these things. Conclusion The main goal for the H.G.P. was to figure out the complete puzzle of human genome for further study. If you think about it, the Human Genome Project could make people rethink life itself because there is so much technology today that is being used for medical purposes. But you have to think of this new field of science is like opening Pandora’s Box because we don’t know if there are side effects to these treatments and ideas. In conclusion, the Human Genome Project is the start of amazing new ideas to cure cancer or rare diseases, but is it right to mess with life?

6 Months Later :: essays research papers

6 Months Later Now that Lennie is out of the way, I guess that I can actually do something with my life. But, It's been 6 months since leaving the farm and I still don't have a job. Oh, here's a sign. A mentally handicapped hospital needs an attendant. I can do that, and it pays well too. $150 a month. "At that rate, I'll be able to get that land soon enough. Ain't that right," I asked Candy? "We sure are," he replied with enthusiasm. As we stepped into the complex, the first thing I saw was the reception desk with a young, pretty, receptionist sitting behind the desk, polishing her nails. Lennie would have enjoyed watching her I pondered. She asked us what we wanted, and I told her that we were just here to find out 'bout the job. After getting a quick overview and job description, I was ready to work right away. Candy was also lucky enough to get hired as a nurse for $100 a month. I stepped into the bedroom and I saw about 25 kids sitting around a middle-aged man, listening to a story. As I stepped in, the story teller stepped over to me and told me what I had to do. Educate them and talk to them. That was it. I was getting paid $150 just to teach a group of handicapped kids. I sat down next to the story teller, Bob, and I looked around and carefully observed them. As I did this, I could see Lennie's face flashing in my mind. What was happening to me. Why couldn't he just leave me alone. I survived through my first day of work, reluctantly. The hospital also provided housing. That night, I had the most horrible dream of my life. I could see Lennie petting hundreds of rabbits, one at a time. But he was crying and screaming in rage. The rabbits were dying. "George, why do they die? Don't let them die George, please. Can I still tend the rabbits? I know I done a bad thing," exclaimed Lennie. I got up, screaming. "Lennie, please leave me alone, please," I asked. It was silent. Nobody was awake. I looked like a complete nut with all those kids, including Candy, staring at me. Candy just went back to sleep. He was the only one that could understand the pain that I was going through. This happened to me several nights after the first nightmare. Each one would consist of rabbits, lots of them, and Lennie.

Health Insurance and Medicare Essay

I. Introduction The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010 by President Barack Obama. Along with the Health Care and Education Reconciliation Act (HCERA), it represents the momentous transformation of the U.S. health care system. Its main goal is to decrease the amount of uninsured citizens as well as to reduce the overall costs of health care. It is a vastly complex reform that will affect many people in aspects of their health care, costs, and the country. There are many opinions about how this reform will affect the nation, some saying it will make us better off, others saying we will be worse off, and those who do not think it will make a difference. But regardless of these opinions, what the majority does agree on is that these laws may be difficult to understand and that many are not even aware of these changes. There are many problems that the health care industry is facing. The cost of health care may arguably be the most important factor that people are concerned about. Many think that health care policies and premiums are too expensive. Coupled with the fact that our population is aging, meaning that there will be more elder people with more health problems, health care costs are rapidly growing and take up a huge chunk of the federal budget. There are also many loopholes within the current health care system. Individuals who are looking to buy insurance can be denied based on their pre-existing conditions. Some insurance policies even have a lifetime limit on benefits. What all these examples basically sum up is that the people who are in need of health care the most are those who are also the most unlikely to be insured, or are under insured. In an attempt to address these issues, the PPACA and Reconciliation Act were established. The Health Care and Education Reconciliation Act was enacted to amend the PPACA. It is divided into two titles, one addressing the health reform and the other addressing student loan reform. It makes changes to some parts of the PPACA. That is why many people commonly refer to the overall health reform as just the PPACA. The most noted change this brings  is that it requires almost all citizens to have health care insurance, or to pay a penalty. Some examples and cases regarding this issue will be discussed later on. The PPACA also considerably expands public insurance as well as funds private insurance coverage. It will close loopholes such as setting life time limits as well as making it illegal to reject coverage for those with pre-existing conditions. In terms of affordability, the PPACA will expand Medicaid to cover low-income families and individuals across the nation. It also aims to cut down and reconstruct Medicare spending, which will be the main focus of this paper. II. The Impacts of the PPACA and HCERA on Medicare and Health Physicians The PPACA is made up of 10 titles. I will be discussing selected provisions in Titles II, III, IV, and V regarding Medicare. These include program modifications and payment to Medicare’s fee-for-service program, the Medicare Advantage, prescription drug programs, Medicare’s payment process, changes to address, waste, fraud, and abuse, and other miscellaneous Medicare changes. As for the HCERA, the first title has provisions detailing health care and revenues. Subtitle B of Title I involves provisions that change provisions PPACA relevant to those listed above (Medicare Advantage, fee-for-service, and prescription drug programs). Subtitle D has provisions regarding decreasing fraud, abuse, and waste in Medicare. Subtitle E discuses revenue related provisions such as a provision that changes Medicare tax provision in PPACA. A. Impacts on Medicare According to the Congressional Budget Office (CBO), the provisions in PPACA as amended by the HCERA will reduce direct spending by an estimated $390 billion (CRS, 2010). The provisions that are predicted to produce the largest savings include the following: (1) developing an Independent Payment Advisory Board to create changes in Medicare payment rates is presumed to save about $16 billion (2) decreasing Medicare payments to hospitals that aid a vast number of low-income patients, is expected to reduce expenditures by an estimated $22 billion (3) permanent deductions to Medicare’s fee-for-service payment rates (4) changing the high-income adjustment for Part B premiums, and (5) making maximum payment rates in Medicare Advantage closer to spending in fee-for-service Medicare. However, it is critical to  note that these are just estimates. Medicare is made up of four parts that are each accountable for paying for various benefits, dependent on different eligibility criteria. Under traditional Medicare, Part A and Part B services are usually paid by a fee-for-service basis (services supplied to a patient is reimbursed through a separate payment). Part A supplies coverage for skilled nursing facility (SNF) services, inpatient hospital services, hospice care, and home health care, which are subject to some limitations. Provisions that reduce Part A spending make up a large part of the savings related to this legislation through either payment changes or constraining payment updates. PPACA will alter Medicare’s payment updates to Part A hospitals to account for cost savings, which will significantly reduce Medicare spending in the next 10 years. Under PPACA (Title III Subtitle A Section 3001), beginning for discharges on October 1, 2012 hospitals will acquire value-based incentive payments from Medicare. The first year of the value based purchasing (VBP) program will aim at collecting data and assessing performance. Starting in 2013, adjustments to hospital payments will be made based on performance by the VBP program. There will also be VBP standards established (i.e. levels of improvement and accomplishments), as well as a method for assessing how hospitals perform. Hospitals with the highest score will obtain the biggest VBP payments. Those that meet or go beyond the standards are able to receive an increased DRG payment for each discharge within the year. However, to provide for these VBP incentive payments the DRG payments will be reduced by a certain percentage: 1.0% in 2013; 1.25% in 2014; 1.5% in 2015; 1.75% in 2016; and 2.0% in 2017. An alternate choice to receive covered benefits would be Medicare Advantage (MA). Private health plans are paid a per person amount to supply all Medicare-covered benefits to those who enroll in the plan under MA. The payments made to MA plans are decided by comparing the maximum amount Medicare will pay for benefits with a plan’s cost of providing those required benefits. If the plan’s cost is below the maximum, then it is paid  the cost plus a rebate equal to 75% of the difference to the maximum. But if the plan’s cost is above the maximum, then it is paid and must also charge the enrollee the difference between the cost and the maximum. PPACA modifies how the maximum payment is decided. Beginning in 2012, it will implement benchmarks (maximum amount Medicare will pay for benefits) calculated as a percentage of per capita FFS Medicare spending. It will also increase benchmarks depending on the quality of the plan. Those with a high quality rating will get an increase in their benchmark while new plans or those with lesser enrollments may also qualify to get an increase. PPACA will also vary the plan rebates based on quality with new rebates set from 50% to 70%. In regards to changes affecting Medicare’s prescription drug benefits, the health reform makes a few changes to the Medicare Part D program. PPACA increases the premiums held by higher income enrollees. The income standards are set to be at the same manner and level as that in Part B. Beginning in 2011, those enrolled in Part D will have a 50% discount for drugs during the coverage gap. In extension, HCERA will supply a rebate of $250 to those who enter the gap in 2010. Hopefully this phases out the â€Å"donut hole† (coverage gap) by slowly lessening the cost-sharing and coverage gap for generic and brand name drugs. Medicare’s finances are operated through two trust funds, the Hospital Insurance (HI) and the Supplementary Medical Insurance (SMI) trust fund. The main provider of income to the HI fund, which pays for Medicare Part A, is the payroll taxes paid by employers and employees. Medicare Part B and D are funded by general revenues and monthly premiums. In addition to all the previous provisions addressing Medicare’s financial issues, there is another precautionary step being taken. The PPACA has a provision to establish an Independent Payment Advisory Board with the goal of decreasing Medicare spending. B. Impacts on Physicians The PPACA and HCERA make various changes to the Medicare program, which in turn affects physicians and how they practice. Some of these provisions have clear consequences, such as immediately changing physician reimbursement, while others have indirect influences on how physicians may practice in the  future by modifying the incentives to improve the delivery and quality of care. PPACA broadens the Medicare Physician Quality and Reporting Initiative (PQRI) incentive payments though 2014 and administers a penalty for those who fail to report quality measures starting in 2015. It also supplies for a further bonus to physicians who meet the requirements of an assessment program, such as the Maintenance of Certification Program, while penalizes the physicians who fail to meet those standards in the future. Under Section 3002 of Title III, Medicare claims data will be used to provide reports to physicians that measure resources used to provide care for Medicare beneficiaries. Under Section 3007 of Title III, the Secretary of HHS is obliged to create and administer a separate payment modifier to the Medicare physician fee schedule. This payment should be based on the relative cost and quality of the care provided by physicians. The quality of care should be assessed based on risk-adjusted measure of quality determined by the Secretary. Costs are also assessed based on measures determined by the Secretary. Risk factors such as ethnicity, demographic, socioeconomic characteristics, and health status should be taken into account. By January 1, 2012 these explicit measures of cost and quality, along with implementation dates of the adjusted payments should be published. III. Regulations & Implementation With such significant changes and provisions being made, there should be a way to keep track of how each is being regulated and implemented. I will discuss the regulations, time limits, and effective dates on how each are being done so by year. The first changes of 2010 start with Medicare provider rates. This includes reductions in the annual market basket updates for hospital services. Currently, there have been productivity adjustments added to market basket update in 2012. The Centers for Medicare and Medicaid Services (CMS) have issued these updates for varying provider types starting in August 2010. The  implementation of the Medicare Beneficiary drug rebate, which supplies a $250 rebate to those in the Part D coverage gap, started January 1, 2010. In May 2010, the CMS published a brochure containing information about the coverage gap in Medicare Part D. As of March 22, 2011, about 3.8 million people have received the $250 rebate (HHS, 2011). As for closing the Medicare drug coverage gap, on December 17, 2010 CMS sent a letter to pharmaceutical companies addressing guidelines to the Medicare Coverage Gap Discount Program. This program became effective on January 1, 2011. Moving onto provisions implemented in 2011, Medicare payments for primary care will provide a 10% bonus payment for services. It will also provide the same bonus to general surgeons working in areas with a shortage of health professionals. This is being implemented starting in January 1, 2011 through December 2015. As for the MA payment changes, they will restructure payment to private plans and prohibit higher cost-sharing requirements. This has been in effect since January 1, 2011. The CMS issued a notice to MA plans in April 2010 addressing the freeze in 2011 payment rates at 2010 levels. A Medicare Independent Payment Advisory Board made up of 15 individuals to arrange proposals and recommendations to decrease the per capita rate of growth in spending if it exceeds targeted rates was planned to be established. On October 1, 2011, funding was made available and the first proposals are due January 15, 2014. In 2012, the second part of the MA plan payments, which reduce rebates paid and provide bonuses to high quality plans, went into effect on January 1, 2012. On February 28, 2012 the CMS sent out a letter to MA plans addressing the payment rates for 2012. Fraud and abuse prevention was also implemented on January 1, 2012. It establishes procedures for screening and reporting those who participate in Medicare. On March 23, 2011 CMS issued a notice addressing the fee that providers would have to pay to fund the screenings. Later on in the year, on October 1, 2012 Medicare value based purchasing was put into effect. This creates a program to pay hospitals based on their quality of performance. This coming year in 2013, there will be a few provisions to come into effect  starting off the new year. On January 1, 2013 the Medicare tax increase (increases the Medicare Part A tax rate on wages by 0.9% on incomes of $200,000), Medicare bundle payment pilot program (program to create and assess payments for certain services), and the latter part of the prescription drug coverage gap (reducing coinsurance) will be put into effect. As for 2014, the last of the Medicare provisions will be implemented. The Medicare Advantage plan loss ratios are mandated to be no less than 85%; this will begin at the start of the year on January 1, 2014. The second implementation for that year will be Medicare payments for hospital-acquired infections; it will decrease payments to those hospitals for their hospital-aquired conditions by 1% and this process will continue onto 2015. IV. Cases Challenging PPACA When the PPACA and HCERA were signed into law, many people opposed and sued claiming that the reform was unconstitutional for a number of reasons. The most controversial was the mandate that require most citizens to obtain health insurance coverage, and if failing to do so would have to pay a penalty in the form of an individual tax. Another debated provision was the expansion of the Medicaid program to cover even more individuals, such as those with low income. All of these separate cases were then merged into a single case, The National Federation of Independent Business v. Sebelius, 567 U.S. (2012). When ruled, it was a momentous Supreme Court decision in which the Court maintained Congress’s authority to enact the provisions of the Affordable Care Act and the Reconciliation Act. In December 2011, it was announced that there would be a 6 hour oral argumentation heard by the Court over a time span of three days beginning on March 26, 2012 and ending on March 28, 2012 discussing varying debatable topics of these provisions. By a vote of 5 to 4, the Court maintained the Individual Mandate aspect of the PPACA as a binding exercise of Congress’s authority to lay and collect taxes. The critical characterization of this financial penalty as a tax is what passed the mandate as constitutional. Preceding this landmark case there were many previous hearings held, all  having similar conflicting opinions. The Eleventh Circuit was also dealing with arguments in relative cases challenging PPACA. While it was assumed that the Fourth Circuit, which had heard oral arguments before the Eleventh Circuit, would issue a decision on PPACA first, the Eleventh Circuit was actually the second to issue its opinion, on August 12, 2011. In Florida ex rel. Bondi v. U.S. Department of Health & Human Services (2011) the plaintiffs of the case were two private individuals, the National Federation of Independent Business, and 26 individual states. The Eleventh Circuit then published a 300-plus page opinion finding by a 2:1 majority that the Individual Mandate (requiring health insurance coverage) is unconstitutional, and thus created a split of authority between the two Circuits. The Eleventh Circuit heard this appeal from the United States District Court for the Northern District of Florida, which saw the Individual Mandate to be an unconstitutional exercise of Congress’s authority. The district court also found that the Individual Mandate was not applicable to the rest of the PPACA, meaning that the whole act was invalid. The plaintiffs in the district court case also debated that the PPACA’s expansion of Medicaid was unconstitutional, but the district court granted the government judgment on that issue and the Eleventh Circuit agreed to that court’s decision. These two cases show how divided opinions can be and how difficult it was and is to pass a health reform law. Opinions are still divided, concerning many aspects such as the Medicaid expansion, the Commerce Clause, and the Necessary and Proper Clause. On the issue of Medicaid expansion, no one, single opinion had the support of the majority of the Justices. Also, on the issue of if the Individual Mandate was within the authority of Congress under the Commerce Clause and the Necessary and Proper Clause, again there was no single opinion that was supported by the majority of the Court. Despite all these controversies, and even though the act has passed, there are still those who are continuing to pursue litigation in order to repeal and defeat the PPACA. V. Conclusion Medicare spending has been increasing much more rapidly compared to the general economy, and this definitely raises concerns about Medicare’s  long-term sustainability. The provisions in the Affordable Care Act and the Reconciliation Act were established to decrease Medicare program costs by about $390 billion over the following 10 years through modifications in payments to various providers, by leveling payment rates between fee-for-service Medicare and Medicare Advantage, and by boosting efficiencies of how health services are delivered and paid for. Overall, the PPACA and HCERA are momentous pieces of legislation that will restructure the future of the U.S. health care system. It is still unclear of how well these provisions have been implemented, with some still having yet to be so. The main concern is probably how well costs will be contained or reduced. With all of these new taxes, hopefully the reform will actually reduce the federal deficit over the next ten years that these provisions are being implemented. There is still much work to be done within the next few years, to see how this reform works out. Many people are glad that it has passed and support this reform as well as encourage it to be expanded, while others oppose the reform arguing that it creates too much government involvement in the issue. But since it has passed and is enacted in the present, people should make use of what is being provided. Some are not even aware of the changes in the health care industry and are oblivious to how they are being affected. That is why it is important to stay informed and make decisions, after all this is what directly affects your future. References CRS Analysis of CBO (March 20, 2010). Estimates of the effects of PPACA and the Reconciliation Act combined. Congressional Budget Office. Retrieved October 31, 2012 from: http://www.cbo.gov/ftpdocs/113xx/doc11379/AmendReconProp.pdf Barrett, Paul M. (June 28, 2012). Supreme Court Supports Obamacare, Bolsters Obama. Bloomberg Businessweek. Retrieved November 3, 2012 from: http://www.businessweek.com/articles/2012-06-28/supreme-court-supports-obamacare-and-bolsters-obama Congressional Budget Office (March 2009). An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act. Letter to the Honorable Evan Bayh. Congressional Budget Office, Washington, DC. Retrieved November 3, 2012 from: http://www.cbo.gov/doc.cfm?index=10781. Kaizer, J. (2010). Implementation Timeline. Health Reform Source. Retrieved November 5, 2012 from: http://healthreform.kff.org/timeline.aspx Hilgers, David W. (February 2012) Physicians post-PPACA: not going bust at the healthcare buffet. The Health Lawyer, Vol. 24. Retrieved November 4, 2012 from: http://www.americanbar.org/content/dam/aba/publishing/health_lawyer/health_mo_premium_hl_healthlawyer_v24_2403 Pozgar, George D. (2009). Legal essentials of health care administration. Missisauga, Ontario: Jones and Bartlett Publishers, Michael Brown. National Federation of Independent Business v. Sebelius, Secretary of Health & Human Services 567 U.S. (2012) No. 11-393 Argued March 26-28, 2012 – Decided June 28, 2012 Florida ex rel. Bondi v. U.S. Department of Health a& Human Services, 780 F.Supp. 2d. 1256 (N.D. Fla. 2011), order clarified by 780 F.Supp. 2d. 1307. (N.D. Fla. 2011).