RESUMO
This RCD discusses a recent decision by the United States Court of Appeals for the First Circuit that struck down Puerto Rico's Act 90-2019, which aimed to regulate pay structures for Medicare Advantage insurers in Puerto Rico. The court found that the provision in Act 90, known as the "Mandated Price Provision," is preempted by federal law. However, the author argues that the court's decision did not adequately consider the congressional intent of the Medicare Advantage Act in weighing the public health crisis in Puerto Rico. The RCD provides background on the Medicare Advantage program and Act 90 and explains how Act 90 aimed to eliminate insurers' practice of paying providers at rates below the CMS's minimum reimbursement rates under the traditional Medicare program. The article concludes that the court's decision inadequately considered the larger purpose of the Medicare Advantage Act and the relevant public health crisis in Puerto Rico.
Assuntos
Medicare , Saúde Pública , Idoso , Estados Unidos , Humanos , Porto RicoRESUMO
We examined the extent to which supply-side, niche, and competition theories and concepts help explain a trematode community in which one species comprises 87% of the trematode individuals, and the remaining 15 species each have <3%. We collected and dissected the common and wide-ranging snail host Heleobia australis over four seasons from three distinct habitats from the intertidal area of the Bahía Blanca estuary, Argentina. Inside a snail, trematodes interact with each other with outcomes that depend on facilitation, competition, and preemption, suggesting that dominant species should be common. The abundant trematode species, Microphallus simillimus, is a weak competitor, but has life-history traits and strategies associated with higher colonization ability that could increase its probability of invading the host first, allowing it to preempt the rare species. Rather than segregate by habitat, trematode species aggregated in pans during the summer where dominant trematode species often excluded subordinate ones. Despite losses to competition, and a lack of niche partitioning, M. simillimus ruled this species-rich trematode guild through strong recruitment and (potentially) preemption. Therefore, extremely skewed species abundance distributions, like this one, can derive from extremely skewed colonization abilities.
Assuntos
Trematódeos , Animais , Argentina , Ecossistema , Interações Hospedeiro-Parasita , CaramujosRESUMO
Este ensaio pretende abordar o enfoque preemptivo no campo das práticas preventivas em saúde, especialmente quanto à ideia de ataque antecipatório no enfrentamento dos riscos que nos ameaçam. Há perspectivas que apontam para uma suposta imprecisão teórica do conceito "medicalização". Mesmo sendo este ponto de vista passível de discussões, propomos a expressão "terapeuticalização" para designar práticas relacionadas ao cuidado em saúde, com especial ênfase nas tecnologias de auto monitoramento da saúde que coletam dados que permitem às pessoas um esquadrinhamento constante de funções biológicas como forma somática de produção de subjetividade. Parece haver uma abrangência que está se ampliando gradualmente para o uso de auto monitoramento, que provavelmente deve se expandir, na medida em que um crescente número de organizações e instâncias se dê conta do potencial dos dados produzidos a partir dessas práticas. O auto monitoramento pode ser visto como uma estratégia biopolítica utilitarista que coloca o "si mesmo liberal" como um cidadão responsável, com vontade e capacidade de tomar cuidado de si, de sua felicidade, de seus autointeresses.
This essay aims to address the preemptive approach in the field of preventive health practices, especially regarding the idea of anticipatory attack in dealing with risks that threaten us. There is a concern that purports that the concept of "medicalization" is af fected by lack of theoretical precision. Even being an arguable point of view, we propose the term "thera peuticalization" to describe such practices, with special emphasis on health self-tracking technolo gies, that collect data that allow people to perform a constant follow-up of biological functions as a somatic self-enterprise. There seems to be a gradual expansion of the use of self-monitoring that tends to grow, as an increasing number of organizations and authorities realize the potential of the data gathered from these practices. Self-monitoring can be seen as an utilitarian biopolitical strategy that put the liberal self as a responsible citizen, willing and able to take care of himself/herself, his/her happiness, his/her self-interests.