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PLSC 365 “U.S. HEALTH CARE POLICY & POLITICS”
Fall 2006 – Professor Rick Mayes
7-9:45 p.m. Wednesdays, Weinstein 203
Phone:x6404; Email:
Office Hours: 3:30-4:45 p.m. Mondays & Fridays (if these times are not convenient for you, we can always set up one that is)
Website:
As the Economist points out, “Everybody needs health care; it never goes out of fashion; and most people are willing to pay for it. No wonder America has been so much faster than Europe to turn health care into a business.” One can reasonably argue that there are few subjects as controversial, debated and fought over, lucrative for some, and expensive for others (individuals, companies, and the country at 16% of GDP) as health care. Moreover, no issue is as intensely personal to every individual. Life begins and ends within the health care arena, often in the same place and with the same professionals: in a hospital with physicians and nurses. These are just the two most notable examples of each person’s experience with health care. All the other ones in between are too infinite to categorize.
“Health care policy” is actually a large, umbrella term for a myriad of directly and indirectly related topics including: managed care, nurses, doctors, hospitals, health insurance, medical care for the poor (Medicaid/SCHIP), medical care for the disabled and those over the age of 65 (Medicare), medical care for veterans (the VA), corporate health insurers (Aetna, Cigna, United Healthcare, WellPoint), complimentary and alternative medicine (CAM), mental health, public health, pharmaceutical drugs, long-term care (nursing homes), hospice care, disease control and prevention (CDC), medical research, employment fringe benefits, collective bargaining agreements, medical licensing, environmentalism, food & drug safety (FDA), the federal budget, and more.
Ultimately, this course provides an analytical framework for examining both the goals of health policy (equity, security, efficiency, liberty) and the proposed solutions (rules, rights, incentives, sanctions) that are commonly used in political conflicts over health issues. And as we will learn, few issues carry so much political risk for so little political reward as health care reform. Therefore, studying health care policy and politics is not only interesting and important in its own right, it also serves as a particularly effective tool for better understanding how our national and state governments address major policy issues (or how and why they often fail to).
Texts
- Atul Gawande, Complications: A Surgeon’s Note on an Imperfect Science (Picador)
- Paul Starr, The Social Transformation of American Medicine (Basic Books)
- Tracy Kidder, MountainsBeyondMountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World (Random House)
- Margaret Mohrmann, Attending Children: A Doctor’s Education (Georgetown University Press)
- Jonathan Oberlander, The Social Medicine Reader, Vol. 3: Health Policy, Markets, and Medicine (Duke University Press)
- Eric Schlosser, Fast Food Nation: The Dark Side of the All-American Meal (Houghton Mifflin)
recommended: R. Donaldson, et al., The Yale Guide to Careers in Medicine & the Health Professions (Yale University Press)
Paul Feldstein, Health Policy Issues: An Economic Perspective (3rd edition, HAP Press)
Assignments, Exams, Group Projects
Mid-Term Exam30%
“Comparison Reaction” papers20%
Class Preparation & Participation 5%
Team Debates10%
10-page Research Paper10%
Final Exam25%
“Comparison Reaction” papers of Selected Weekly Readings (20% of grade– 1 point each)
You will turn in twenty (20) 1-2-page, single-spaced Comparison Reaction papers(indicated by an * on the following dates: August 30; September4,11,13,25,27; October 2,9,11,23,25; November 1,6,8,13,15,27,29; December 4,6). Each paper consists of an analysis and comparison of two readings’ main argument(s) and a section in which you explain your reaction(s) to them. A few readings are long enough that you are not asked to compare it to another reading; simply analyze the author’s arguments and detail your reaction(s). For the format of theseComparison Reaction papers, see the last page of this syllabus. You will receive a grade of “check minus” (0.5 points) or “check” (1 point).
Honor Code: Every assignment and exam must be submitted with your signature next to the full written pledge:
“I pledge that I have neither received nor given unauthorized assistance during the completion of this work.”
Class Preparation & Participation (5% of grade)
Although attendance is not mandatory, a portion of each student’s final grade will be determined by his or her weekly participation. All students are expected to attend every class period ready with questions and comments. The preparation and participation component of your final grade is substantial (half of a letter grade). Though I rarely, if ever, take a formal roll, I know who is present and who is absent for each class. I will operate the course as a graduate-level seminar, so it is essential that you have done all the readings and analysis for every class.
Team Debates (10% of grade)
You will split up into teams of 3 members, take a position on a policy debate, and present it to the class. After Q&A, the class will then vote on which side made the more convincing argument. Debate dates are as follows:
October 2 and 4 November 1 and 29
Grades
"Abandon hope, all ye who have become accustomed to grade inflation."
Everyone begins the class with zero (0) points. Through class participation, summary critiques, papers, exams, and debates, you earn points over the course of the semester. The number of points you earn determines the grade you receive. Many aspects of life are similar in this regard. Moreover, I grade on a curve. D/F is representative of work that is poor-incomplete; C, adequate; B, excellent; and A, extraordinary(and rare).
ScoringA= 100-95A-= 94-91 B+= 90-88
B= 87-84B-= 83-81 C+= 80-78
C= 77-74 C-= 73-71 D+= 70-68
D= 67-64 D-= 63-61 F= 60-0
Research Paper (10% of grade): (approximately 10double-spaced pages: due Friday, December 6)
Pick any health-related topic and pose a research question(s) around it (e.g., Does Medicaid and SCHIP coverage vary by state? If so, how and why does it vary, and what are some of the major economic, health, and political consequences for this variation?). Become the University of Richmond’s leading expert on the topic. Choose your topic from the list on the first page (paragraph 2), or something else of your own liking (e.g., tobacco regulation/litigation, needle-exchange programs, patent policy and generic drugs, whatever you find especially interesting). If you need help in refining a topic, please come and see me. The Internet links below andPubMed and Health Affairs are good sources to look for issues and information.
Your paper will be graded on the basis of three criteria: (1) content, (2) writing style (e.g., organization, clarity, logic, and technical presentation), and (3) the extent of empirical analysis you have performed. Later on in the semester I will hand out a paper-tips sheet to help you. Also, please avail yourself of the WritingCenter’s services. Good writing takes time, discipline, and a commitment to improvement.
* A 1-page overview of your topic, why you chose it, and what questions you seek to answer is due by Monday, November 20. *
Late Policy
My policy is firm but fair. I don’t expect to use this policy, but if it has to go into effect it will. In brief, paper grades will be automatically reduced one full grade for every day late. Any paper submitted more than 2 days late will receive an automatic “F.” Those with genuine emergencies will be given extensions, but they must be cleared with me in advance.
Sample of Internet Sites with Health Care Information & Data
(Health Affairs) **
(PubMed) **
READINGS & ASSIGNMENTS
August 30:*Atul Gawande, Complications:A Surgeon’s Note on an Imperfect Science
Wednesday
PBS’s “Children’s Hospital: Pioneers”
(^ not a reading, just scan ^)
(^ not a reading, just scan ^)
I. HISTORICAL, ECONOMIC, & POLITICAL DEVELOPMENT of U.S. HEALTH CARE
September 4:The Early Years of American Health Care: George Washington to the Civil War
Monday
*Starr, The Social Transformation of American Medicine, Book One, pp. 30-78
September 6:Medical Care’s Post-Civil War Metamorphosis
Wednesday
Starr, The Social Transformation of American Medicine, Book One, pp. 79-144
PBS Frontline’s “The Alternative Fix” (November 2003)
(^ watch the 1-hour program online ^)
September 11:Epidemics and the Origins of Public Health in America
Monday
Starr, The Social Transformation of American Medicine, Book One, pp. 180-197
*M. Gladwell, “The Three Rules of Epidemics,” Chapter 1 of The Tipping Point
*H. Epstein, “Ghetto Miasma: Enough to Make You Sick,” New York Times Magazine (October 2003)
PBS’s “A Paralyzing Fear: The Story of Polio in America” (^ watch the 1-hour program on UofR cable ^)
September 13:*C. Burr, “The AIDS Exception: Privacy vs. Public Health,” The Atlantic Monthly (June 1997)
Wednesday
*M. Specter, “Higher Risk: Crystal Meth, the Internet, and AIDS,” The New Yorker (May 2005)
PBS Frontline’s “The Meth Epidemic”
(^ watch the 1-hour program online ^)
September18The Mirage of National Health Insurance and the Rise of Private Security, 1930s-1970s
Monday
Starr, The Social Transformation of American Medicine, Book One, pp. 145-179, 198-232
Mayes, Universal Coverage, Chapter 1 “Introduction”
September 20Clinton’s Failure and the Managed Care Revolution, 1980s-mid 1990s
Wednesday
Oberlander et al., eds., The Social Medicine Reader, pp. 95-127
Mayes, Universal Coverage, Epilogue, pp. 167-172
P. Starr, “What Happened to Health Care Reform?” American Prospect (Winter 1995)
“President Clinton’s 1993 Health Care Address to Congress” (^ watch the 1-hour program on UofR cable ^)
September 25The Managed Care Backlash & Patient Dilemmas, mid 1990s-present
Monday
Mayes, Universal Coverage, Epilogue, pp. 147-155, 172-175
*Series, “Modern Patient Dilemmas,” New York Times (2005)
Oberlander et al., The Social Medicine Reader, pp. 5-22, 240-244
September 27Health Savings Accounts, “Pay for Performance” Reimbursement, and U.S. Health Care in Flux
Wednesday
Oberlander et al., The Social Medicine Reader, pp. 246-259
*A. Gawande, “Piecework: Medicine’s Money Problem,” The New Yorker (May 2005)
*A. Gawande, “Annals of Medicine: The Bell Curve,” The New Yorker (December 2004)
*M. Gladwell, “The Moral-Hazard Myth,” The New Yorker (August 2005)
II. INDIVIDUAL TOPICS INVOLVING PUBLIC POLICY, LAW, and HEALTH CARE
October 2:TEAM DEBATE (smoking litigation, federalism, and the 1998 Master Settlement Agreement)
Monday
Moot Court: States’ Attorneys General vs. Tobacco Companies
M. Derthick, “Federalism and the Politics of Tobacco,” Publius (2001)
*J. Nocera, “If It’s Good for Philip Morris, Can It Also Be Good for Public Health?” New York Times Magazine
PBS Frontline’s “Inside the Tobacco Deal”
October 4:TEAM DEBATE (civil rights, public health, and prenatal cocaine screening)
Wednesday
Moot Court: Fergusonvs. Charleston(U.S. Supreme Court, 2001)
October 9:Mental Health: History, Psychopharmacology, and Children & Adolescents
Monday
*D. Sanghavi, “The Secret Truth: Vaccines, Public Health and Autism,” The Boston Globe (January 2006)
A. Spiegel, “The Dictionary of Disorder: Robert Spitzer and DSM-III,” The New Yorker (January 2005)
*J. Mahler, “The Antidepressant Dilemma,” New York Times Magazine (November 2004)
PBS Frontline’s “Medicating Kids” (April 2001)
(^ watch the 1-hour program online ^)
October 11:Mental Health: The Dilemma of Happiness and How Mental Disorders Affect Individuals and Families
Wednesday
*J. Gertner, “The Futile Pursuit of Happiness,” New York Times Magazine (September 2003)
*G. Easterbrook, “Psychology Discovers Happiness,” The New Republic (February 2001)
PBS, “Refrigerator Mothers” (read this interview transcript)
FALL BREAK (* read Kidder’s MountainsBeyondMountainsand prepare for mid-term over break *)
October 18:MID-TERM EXAM
Wednesday
October 23:Human Rights & International Public Health
Monday
*Kidder, MountainsBeyondMountains, pp. 3-177
October 25:Human Rights & International Public Health
Wednesday
*Kidder, MountainsBeyondMountains, pp. 181-301
October 30:Medical Malpractice Reform
Monday
Mayes,Universal Coverage, Epilogue, pp. 165-167
*A. Chandra, et al., “The Growth of Physician Medical Malpractice Payments,” Health Affairs (2005)
*A. Gawande, “Malpractice Reform,” The New Yorker (November 2005)
November 1:TEAM DEBATE (Rising Prescription Drug Costs: Australia’s PBS vs. Maine’s “Express” Rx Drug Plan)
Wednesday
*M. Gladwell, “High Prices: How to Think About Prescription Drugs,” The New Yorker (October 2004)
*J. Kleinke, “Access versus Excess: Value-Based Cost Sharing for Rx Drugs,” Health Affairs (2004)
PBS Frontline’s “The Other Drug War” (June 2003)
(^ watch the 1-hour program online ^)
November 5movie “Super Size Me” (7-8:45 p.m., location TBA)
Sundaynight
November 6:The Fast Food Industry and Public Health: Meat and Potatoes
Monday
*Schlosser, Fast Food Nation, Chapters 5-10 and Epilogue (pp. 111-270)
November 8:The Fast Food Industry and Public Health: Obesity and Vegetarianism?
Wednesday
*E. Weil, “Heavy Questions,” New York Times Magazine (January 2005)
*M. Pollan, “An Animal’s Place,” New York Times Magazine (November 2002)
November 13:Medicare: Government Health Insurance for the Elderly and Disabled
Monday
Mayes, Universal Coverage, Epilogue, pp. 161-164
*C. Mann, “The Coming Death Shortage,” Atlantic Monthly (May 2005)
*J. Winakur, “What Are We Going To Do with Dad?” Health Affairs (July/August 2005)
November 15:Organ Donation and Transplantation Policy
Wednesday
Oberlander et al., eds., The Social Medicine Reader, pp. 150-157
*G. Reynolds, “Will Any Organ Do?” New York Times Magazine (July 2005)
*R. Steinbrook, “Public Solicitation of Organ Donors,” New England Journal of Medicine (August 2005)
*R. Truog, “The Ethics of Organ Donation by Living Donors,” New England Journal of Medicine (August 2005)
PBS’s “Children’s Hospital: Decisions”
(^ not a reading, just scan ^)
(^ not a reading, just scan ^)
THANKSGIVING BREAK (* read Mohrmann’s Attending Children: A Doctor’s Education over break *)
November 27:Medicaid & SCHIP: Government Health Insurance for the Working Poor & Uninsured Children
Monday
Mayes, Universal Coverage, Epilogue, pp. 155-161
Oberlander et al., eds., Social Medicine Reader, pp. 76-90
*Mohrmann, Attending Children: A Doctor’s Education, pp. 1-50
PBS’s “Children’s Hospital: Counting the Costs”
(^ not a reading, just scan ^)
(^ not a reading, just scan ^)
November 29:TEAM DEBATE (The Judiciary and the Controversy Over the Right to Die: “Gonzales vs. Oregon” 2006)
Wednesday
*Ezekiel Emanuel, “Whose Right to Die?” Atlantic Monthly (March 1997)
*R. Henig, “Will We Ever Arrive at the Good Death?” New York Times Magazine (August 2005)
Oregon’s Death with Dignity Act: 2006 Report
December 4:Write your own “living will/medical power of attorney statement/advanced medical directive”.
MondaySpecify how you would want to be medically treated (sustained or not sustained) in a number of different
physical circumstances and briefly explain why. Without being incomprehensible, try to make your living
will sound as legally professional as possible. Have a roommate or friend co-sign it.
*Mohrmann, Attending Children: A Doctor’s Education, pp. 51-92
PBS’s “Children’s Hospital: Childhood”
(^ not a reading, just scan ^)
(^ not a reading, just scan ^)
December 6:Medicine, Faith and Healing
Wednesday
*Mohrmann, Attending Children: A Doctor’s Education, pp. 93-141
Francis Collins: Director, National Human Genome Research Institute, “Seek a Balanced Life”
University of Virginia’s Commencement Address (May 2001)
(^ read ^)
Research Paper: due by Wednesday, December 6, 7:00 p.m.
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Final Exam: Friday, December 15, 7:00-10:00 p.m.
John Doe TEMPLATE/FORMAT Prof. Mayes
October 11, 2006 PLSC 365
J. Gertner’s “The Futile Pursuit of Happiness” and G. Easterbrook, “Psychology Discovers Happiness”
Analysis of Gertner’s Main Argument(s):
Analysis of Easterbrook’s Main Argument(s):
Reaction(s) to and Comparisons of the Readings:
1.) to Gertner
2.) to Mahler