Georgetown University Law Center

About: Georgetown University Law Center is a based out in . It is known for research contribution in the topics: Supreme court & Public health. The organization has 585 authors who have published 2488 publications receiving 36650 citations. The organization is also known as: Georgetown Law & GULC.

Risk Governance and Democracy in Health Care

Abstract: I argue in this article that the concept of risk-centered governance is the best theoretical paradigm for understanding health law and the health care system. Over the past 20 years, an insurance-inflected discourse has migrated from the purely financial side of the health system into the heart of traditional medicine - the doctor-patient relationship. Rather than focus on doctrinal strands, I argue that scholars should analyze the law of health care as a set of governance practices organized around managing and allocating financial, as well as clinical, risk. Over the same period, the body of law that structures most private group health insurance - ERISA - has effectively delegated control of risk pooling and resource allocation to the employers that sponsor group plans. Drawing on a history of ERISA that has not been explored in legal scholarship, I demonstrate how the private welfare state of workplace-based health insurance has evolved into the creation of what amounts to corporate sovereignty in controlling access to health coverage. The discourse of managing risk bonds these two components of health law and the health care system: patient care and access to coverage. From a normative perspective, the greatest problem with risk-centered governance arises from a democracy deficit. Because almost all health insurance risk pools are based in workplaces, there is potential to draw on the social networks created by work as a mechanism for building new, localized publics engaged with health policy. Treating insurance risk pools as potential mechanisms of governance, rather than merely as actuarial units, would force the publicizing (at least within the workplace) of myriad political decisions: who gets included and excluded in the pooling process, how allocation decisions are made, and whether there are systems of accountability and checks and balances sufficient to produce a risk allocation system that is equitable, as well as efficient and flexible. The article builds on the egalitarian potential of social insurance as a technology of governance, and argues for filling a gap that exists not only in the current system, but also in all proposals for reform.

Mortgage Risk Premiums during the Housing Bubble

Abstract: How did pricing for mortgage credit risk change during the years prior to the 2008 financial crisis? Using a database from a major American bank that served as trustee for private-label mortgage-backed securitized (PLS) loans, this paper identifies a decline in credit spreads on mortgages conditioned on loan and borrower characteristics. We show that observable risk factors, FICO score and loan-to-value ratios, have less of an impact on mortgage pricing over time. As the volume of PLS mortgages expanded and lending terms eased, risk premiums failed to price the increase in risk.

Governing for Health as the World Grows Older: Healthy Lifespans in Aging Societies

Abstract: So much of global health governance focuses intensely on a brief moment in the human lifespan — from a safe birth to infant and child survival. Yet, with all the attention to this early window of life (infancy to age five), the opposite end of the life spectrum is comparatively neglected. The Millennium Development Goals (MDGs) do not mention a healthy lifespan or a healthy old age. This inadequate attention to the older years of the life appears to be a glaring omission given the universal challenges posed by aging societies. Aging is a demographic fact in almost all countries, but it is occurring more rapidly in low- and middle-income countries. Today, almost two in three people aged 60 or over live in developing countries. By 2050, nearly four in five of those aged over 60 will live in the developing world.Across the globe, declining fertility rates, lower infant mortality, and greater longevity drive population aging: people live longer because of improved nutrition, sanitation, health care, education and economic wellbeing. In many respects, therefore, global aging is a triumph of social and economic development. But sitting alongside the stunning success of longer lives (and the future prospect of still longer lives), are the personal, social, and economic consequences of a global demographic transition to a decidedly older population. A fundamental dynamic for global health in the coming decades is to find innovative governance tools to shape the way the international community can enhance the well-being of older people living in aging societies — from civil society, philanthropy, industry, and governments to international agencies and global public-private partnerships. Reflecting on the journey from the new millennium to today, there has been undeniable — although decidedly inadequate — progress. The 2002 Madrid International Plan of Action on Aging (“Madrid Plan”) framed aging policies as integral aspects of economic development and human rights — a form of mainstreaming we support. Yet, more than a decade later, the United Nations processes have failed to yield concrete changes in law and governance.The goal of healthy aging is unmistakable, and benefits everyone equally in society. Society should afford all human beings the opportunity to live dignified and long lives where they are healthy and active for as long as possible, allowing them to continue to enrich their own lives and that of those around them. The challenge of global aging is significant and universal. Almost 700 million people are now over the age of 60, and by 2050, 2 billion people — over 20 percent of the world’s population — will be 60 or older. Recognizing the need to combat this population shift, Anna Garsia and Professor Gostin look at the impact this changing dynamic will have on global health and the structures currently in place. In this Article, Garsia and Gostin analyze the current state of affairs for older persons around the world, looking at both international and domestic efforts and ultimately calling for a course of action that enhances the application of existing human rights law while campaigning for a robust new international treaty on the treatment of elder individuals.

Operationalizing Reverse Bayesiansim

Abstract: Karni and Viero (2013) propose a model of belief revision under growing awareness — reverse Bayesianism — which posits that as a person becomes aware of new acts, consequences, or act-consequence links, she revises her beliefs over an expanded state space in a way that preserves the relative likelihoods of events in the original state space. A key limitation of the model is that reverse Bayesianism alone does not fully determine the revised probability distribution. We provide an assumption — act independence — that imposes additional restrictions on reverse Bayesian belief revision. We show that under act independence, knowledge of the probabilities of new events in the expanded state space is sufficient to fully determine the revised probability distribution in each case of growing awareness. We thereby operationalize the reverse Bayesian model for applications. To illustrate how act independence operationalizes reverse Bayesianism, we consider the law and economics problem of optimal safety regulation.

Constitutional Fictions and Meritocratic Success Stories

Abstract: L.H. LaRue demonstrates in his book, Constitutional Law as Fiction, that, at least in the realm of constitutional law, there is no simple correspondence between fiction and falsehood, or fact and truth. Partial or fictive accounts of our constitutional history, even when they are riddled with inaccuracies, may state deep truths about our world, and accurate recitations of historical events may be either intentionally or unintentionally misleading in the extreme. According to LaRue, the Supreme Court engages in a form of storytelling or myth-making that goes beyond the inevitably partial narratives of fact and precedent. The Supreme Court also tells stories about our collective past - our political and social history - to support the results for which it argues. Nevertheless, LaRue makes clear that criticism of this sort is not his mission. He believes that the Court's misreadings and mistellings of the historical record, like courts' misreadings of fact and precedent, are inevitable and not altogether undesirable. In his book, LaRue shows that the Court uses these stories, which are most assuredly about our past, not so much to tell us the truth about that past, but to establish what might be thought of as foundational myths which then render our constitutional law persuasive. It is therefore a mistake to criticize or even praise these judicially created stories solely by reference to their historical accuracy. Rather - and precisely because they are fiction (or myth), and in some sense are written and intended to be taken as such - they should be evaluated as fiction (or myth). We need ask of these stories not whether they are historically accurate but whether they are true or false as stories, whether they illuminate something important about our lives that the complexities, ambiguities, and uncertainties of historical truth would obscure. This Essay has three parts. In the first part, I will provide a somewhat different account to the question at the heart of LaRue's book: the nature of the "truth" about our society that a judicially authored "story" might possess when that story purports to be about our past, but actually departs in significant particulars from historical fact. In the second part of this Essay, I examine some of the costs attached to this general practice both on and off the Court." In the third and final part of this Essay, I will explore one sort of more or less true story used by the Supreme Court to buttress its affirmative action jurisprudence.