The Affordable Care Act and the Transformation of US Health Care

The neoliberal period was accompanied by a momentous transformation within the US health care system.  As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ‑the Affordable Care Act (ACA)‑ drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named “Accountable Care Organizations” that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right.

Market reforms and privatisation in the English National Health Service

The article examines developments in the marketisation and privatisation of the English National Health Service, primarily since 1997. It explores the use of competition and contracting out in ancillary services and the levering into public services of private finance for capital developments through the Private Finance Initiative. A substantial part of the article examines the repeated restructuring of the health service as a market in clinical services, initially as an internal market but subsequently as a market increasing opened up to private sector involvement. Some of the implications of market processes for NHS staff and for increased privatisation are discussed. The article examines one episode of popular resistance to these developments, namely the movement of opposition to the 2011 health and social care legislative proposals. The article concludes with a discussion of the implications of these system reforms for the founding principles of the NHS and the sustainability of the service.

En torno a la fundamentación de la dignidad personal

Las trágicas experiencias de las guerras mundiales llevaron a la Declaración Universal de los Derechos Humanos promovida por la ONU en 1948. A partir de entonces gran parte de las Constituciones de nueva creación reconocen la inviolabilidad de la dignidad humana. Sin embargo, los redactores de la declaración pusieron empeño en omitir las razones teóricas en las que se fundan dichos derechos, por el temor a que diferencias teóricas aplazaran o hicieran inviable dicho reconocimiento. La fragmentación en la que se halla la antropología filosófica desde hace varios siglos está reclamando un principio unificador de los saberes en torno al ser humano. En este contexto la dignidad humana como experiencia universal se presenta como principio unificador. Seis décadas después sigue pendiente la elaboración de una sólida, y también universalmente aceptable, fundamentación de la dignidad humana y sus derechos fundamentales, cuestión complicada que parece requerir un nuevo avance en la ontología y en la antropología filosófica.

La protección de los derechos al honor, intimidad y propia imagen del menor con suficiente madurez: entre el respeto a sus decisiones y la intervención del Ministerio Fiscal

En virtud del art. 3.1 de la Ley Orgánica 1/1982, de 5 de mayo, cuando los menores tengan suficiente madurez deberán consentir por sí mismos las intromisiones en sus derechos al honor, intimidad y propia imagen. Sin embargo, atendiendo al art. 4 de la Ley Orgánica de Protección Jurídica del Menor, cuando la intromisión tenga lugar en un medio de comunicación seguirá siendo ilegítima, aun consentida por un menor maduro, si se considera contraria a su honor e intereses, debiendo intervenir en su defensa el Ministerio Fiscal. Esta regulación plantea diversas cuestiones relacionadas con la protección de los derechos al honor, intimidad y propia imagen del menor con suficiente madurez —en particular, sobre la función del fiscal como garante de estos derechos y el papel que se otorga al consentimiento del menor— que son objeto de estudio del presente trabajo.

Acceptance of relapse fears in breast cancer patients: effects of an act-based abridged intervention

Objective: Relapse fear is a common psychological scar in cancer survivors. The aim of this study is to assess the effects of an abridged version of Acceptance and Commitment Therapy (ACT) in breast cancer patients.Method: An open trial was developed with 12 non-metastatic breast cancer patients assigned to 2 conditions, ACT and waiting list. Interventions were applied in just one session and focused on the acceptance of relapse fears through a ‘defusion’ exercise. Interference and intensity of fear measured through subjective scales were collected after each intervention and again 3 months later. Distress, hypochondria and ‘anxious preocupation’ were also evaluated through standardized questionnaires.Results: The analysis revealed that ‘defusion’ contributed to decrease the interference of the fear of recurrence, and these changes were maintained three months after intervention in most subjects. 87% of participants showed clinically significant decreases in interference at follow-up sessions whereas no patient in the waiting list showed such changes. Statistical analysis revealed that the changes in interference were significant when comparing pre, post and follow-up treatment, and also when comparing ACT and waiting list groups. Changes in intensity of fear, distress, anxious preoccupation and hypochondria were also observed.Conclusions: Exposure through ‘defusion’ techniques might be considered a useful option for treatment of persistent fears in cancer patients. This study provides evidence for therapies focusing on psychological acceptance in cancer patients through short, simple and feasible therapeutic methods.

The corporate regimen of labour companies in the New Act 44/2015, on 14th October, of labour and investee companies

Act 44/2015, on 14th October, of labour and investee companies, aims to accommodate the different instruments, limits and requirements with which the legal regime of the labour companies is set, to the current economic and legal context where they must develop their economic activity. The purpose of the law is to preserve their special status, while it seeks to modernize its legal structure to ensure the economic solvency of the business plan, without weakening the social profile that is required. The new law includes two organisational figures, ‘labour companies’ and the calling ‘investee companies’, of the last one, only leaving evidence of what is to be understood by them referring its regulation to a subsequent regulatory development. Until the publication of the regulation, our work has focused on the corporate aspect of the labour companies by analysing the modifications made on the typological elements and legal regime of these organisational figures to determine whether the law is the necessary and sufficient instrument to achieve the challenge proposed.