PLSC 365 U.S. HEALTH CARE POLICY & POLITICS Fall 2007 Professor Rick Mayes Thursdays, 7-9:45 p.m., Weinstein 205

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1 1 PLSC 365 U.S. HEALTH CARE POLICY & POLITICS Fall 2007 Professor Rick Mayes s, 7-9:45 p.m., Weinstein 205 Phone: Office Hours: Website: x6404; Mondays & Fridays 3:40-5:00 p.m. (if these times are not convenient for you, we can alway set up one that is) 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. 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. 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). Books - Atul Gawande, Complications: A Surgeon s Note on an Imperfect Science (Picador) - Atul Gawande, Better: A Surgeon s Note on Performance (Metropolitan Books) - Arnold Relman, A Second Opinion: Rescuing America s Health Care (Public Affairs) - Donald Barr, Introduction to U.S. Health Policy (Johns Hopkins University Press) - Tracy Kidder, Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World (Random House) - Eric Schlosser, Fast Food Nation: The Dark Side of the All-American Meal (Houghton Mifflin) - Margaret Mohrmann, Attending Children: A Doctor s Education (Georgetown University Press) recommended: R. Donaldson, et al., The Yale Guide to Careers in Medicine & the Health Professions (Yale University Press) Assignments, Exams, Group Projects Mid-Term Exam 35% 10 Analysis Reaction papers 15% Class Preparation & Participation 5% Team Debate 10% Final Exam 35%

2 Analysis Reaction papers of Selected Daily Readings (15% of grade 10 individual papers, 1.5 points each) You are to turn in ten 1-2-page, single-spaced Analysis Reaction papers over the course of the semester from a selection of assigned readings indicated by an * next to them (the only mandatory papers are for Gawande s Complications and for Kidder s Mountains Beyond Mountains on November 15). Each paper consists of: (a) an analysis of the readings main argument(s), (b) a section in which you explain your reaction(s) to and compare them if you can, and (c) your grade or evaluation of the readings overall quality: A-F. A few readings are long enough that you need not compare them to another reading; simply analyze the author s arguments and detail your reaction(s). For the format of these Comparison Reaction papers, see the last page of this syllabus. You will receive a grade of check minus (1 point) or check (1.5 points). 2 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 Debate (10% of grade) You will split up into teams of 3-4 students, 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: Grades September 13 October 11 November 15 December 6 "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 poorincomplete; C, adequate; B, excellent; and A, extraordinary (and rare). Scoring A= A-= B+= B= B-= C+= C= C-= D+= D= D-= F= 60-0 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) **

3 3 READINGS & ASSIGNMENTS August 30: *A. Gawande, Complications: A Surgeon s Note on an Imperfect Science PBS s Children s Hospital: Pioneers (^ not a reading, just scan ^) (^ not a reading, just scan ^) I. THE HISTORICAL, ECONOMIC, & POLITICAL DEVELOPMENT of U.S. HEALTH CARE September 6: The Early Years: From George Washington to the Civil War to the Rise of Scientific Medicine *S. Shapin, Sick City: Maps and Mortality in the Time of Cholera, The New Yorker (November 2006) *PBS Frontline s The Alternative Fix (2003) (^ watch the 1-hour program online ^) September 13: Infectious Diseases & Epidemics, Vaccinations/Immunizations, and the Importance of Public Health *Gawande, Better: A Surgeon s Note on Performance, Diligence, pp *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) *C. Burr, The AIDS Exception: Privacy vs. Public Health, The Atlantic Monthly TEAM DEBATE 1. (Should HIV/AIDS testing be mandatory, as in Cuba, or voluntary, as in the U.S.?) September 18: Tuesday 7:30pm Guest Speaker: David Hilfiker, Financial Director of Joseph s Hospice House (Washington, D.C.) and September 20: The Mirage of National Health Insurance, the Rise of Private Security, and Clinton s Failed Attempt Barr, Introduction to U.S. Health Policy, pp Mayes, Universal Coverage, Epilogue, pp *Relman, A Second Opinion: Rescuing America s Health Care, pp *Clinton s 1993 Health Care Reform Address to Congress and the Nation September 27: From Medicare Reform to the Rise and then Subsequent Fall of the Managed Care Revolution Barr, Introduction to U.S. Health Policy, pp Relman, A Second Opinion: Rescuing America s Health Care, pp Mayes & Berenson, Medicare Prospective Payment and the Shaping of U.S. Health Care, Introduction R. Mayes, Medicare and America s Health Care System in Transition, Journal of Health Law (Fall 2005)

4 4 October 4: Health Savings Accounts, Moral Hazard, and the Growth of For-Profit Health Care Barr, Introduction to U.S. Health Policy, pp Relman, A Second Opinion: Rescuing America s Health Care, pp *M. Gladwell, The Moral-Hazard Myth, The New Yorker (August 2005) *M. Gladwell, Million-Dollar Murray: Power-Law Distributions, New Yorker (February 2006) October 11: Options for Health Care Reform and Efforts to Improve the Quality of Medical Care Barr, Introduction to U.S. Health Policy, pp , Relman, A Second Opinion: Rescuing America s Health Care, pp *Gawande, Better: A Surgeon s Note on Performance, pp , TEAM DEBATE 2. (Which is the Better Approach to Health Care Reform?) Massachusetts: Make Health Insurance Like Auto Insurance (Mandatory for Individuals) Oregon: Expand Medicaid Eligibility to Cover More of the Uninsured FALL BREAK II. INDIVIDUAL TOPICS INVOLVING PUBLIC POLICY, LAW, and HEALTH CARE October 18: October 21: Sunday night mid-term exam documentary, Super Size Me (9-10:45 p.m., location TBA) October 25: The Fast Food Industry and Public Health *Schlosser, Fast Food Nation, Chapters 5-10 and Epilogue (pp ) November 1: Mental Health: Psychopharmacology, Prisons, and Children & Adolescents *D. Sanghavi, The Secret Truth: Vaccines, Public Health and Autism, The Boston Globe (January 2006) *J. Mahler, The Antidepressant Dilemma, New York Times Magazine (November 2004) *Series, Troubled Children New York Times (2006) *PBS Frontline s The New Asylums (2005) (^ watch the 1-hour program online ^)

5 5 November 8: Human Rights & International Public Health *Partners in Health, Paul Farmer, and Zanmi Lasante (online video documentary) *Paul Farmer (online video presentation at Columbia University Medical Center) Kidder, Mountains Beyond Mountains, pp November 15: Human Rights & International Public Health *Kidder, Mountains Beyond Mountains, pp Gawande, Better: A Surgeon s Note on Performance, pp TEAM DEBATE 3. (Which Approach to Foreign Aid is More Effective: Jeffrey Sach s Interventionist approach or William Easterly s Let Markets Work approach) THANKSGIVING BREAK (* read at least the first half of Mohrmann s Attending Children: A Doctor s Education over break *) November 29: Medicaid/SCHIP, Medicare and the Aging of the Population Barr, Introduction to U.S. Health Policy, pp *J. Winakur, What Are We Going To Do with Dad? Health Affairs (July/August 2005) *A. Gawande, The Way We Age Now The New Yorker (April 2007) *PBS Frontline s Growing Old (2006) (^ watch the 1-hour program online ^) December 6: End of Life Issues, Faith & Hope: Conclusion and Preparation for Final Exam *Mohrmann, Attending Children: A Doctor s Education, pp 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: 2007 Report TEAM DEBATE 4. (The Controversy Over the Right to Die: Gonzales vs. Oregon 2006) ~~~~~~~~~~~~~~~~~~~~~ FINAL EXAM, December 13, 7-10 p.m.

6 John Doe TEMPLATE/FORMAT Prof. Mayes November 1, 2007 PLSC Mahler s The Antidepressant Dilemma and PBS Frontline s documentary, The New Asylums Analysis of Mahler s Main Argument(s): Analysis of PBS Frontline s Main Argument(s): Reaction(s) to and Comparisons of the Readings/Documentaries: 1.) to Mahler Your GRADE: A through F 2.) to PBS Your GRADE: A through F