SYLLABUS
PE
315 AMERICAN HEALTH CARE POLICY
It may be more appropriate to speak of
American health care policies rather
than policy since there are various
policies in different states. However, the national political environment is
one of federalism which is an amalgam of national and state health programs;
thus, overall one can refer to the United States health care policy.
1.
COURSE
OBJECTIVES:
a. To gain an understanding
of the politics
affecting health care policy
b. To understand the
values, structures, and effects
of health care policy in the
c. To do some
comparison with health policies
in highly industrialized, politically developed countries in order to gain some
insights into how other countries similar to the U.S. are handling similar problems and concerns
along with some awareness of the political environments that tend to lead in
directions that sometimes diverge
from each other in health policies and sometimes
converge. Two major political questions in the discussion on health
care policy are (a) whether the policies of developed countries [economically
and democratically] will converge
due to similar economic environments, problems of health care and basic democratic political systems or
(b) whether they will take different
paths and, if so, why. Of course, there is always the possibility of both
some convergence and some
divergence with the usual political
question of why.
2.
FORMAT
OF COURSE:
The daily reading assignments are to be read prior to the date indicated. Thus pp. 20-34 in Barr should be read prior to the date indicated for it.
a. Class time will generally be divided with
lectures and discussion. If readings
have been assigned, we'll check through key items to be sure they have been
noted and understood. We will also do a quick review of information and ideas
from the last meeting in order to maintain continuity and clear up any
questions, inaccurate understandings, etc. This means reviewing the reading
material and the notes from last class before class in order that we can use
this time effectively.
b. Course paper. The paper required for the course will be built in stages since it will reflect different topics as we move through the course. Most of the basic work for the paper will be done in stages and drafts presented so that by the middle of the semester you will have most of the paper done and be in position to revise and polish for the final paper at the end of the course.
--The format for the paper is as follows:
Each section should be between 1 - 2 pages single-spaced or, in computer talk -- font 10, 1½-2 pages single spaced, normal margins. You need not write more.
These should be summary descriptions of ideas, information, arguments, etc. --- For example, the section on whether there is a right to healthcare should indicate some of the different positions taken [a short to modest paragraph for each] and then what you see as the most reasonable position and why.
The sources to be used are the class lectures and discussion and the assigned readings. I have indicated some optional readings in this syllabus and may point out others during the course of the semester. They are optional; but can be used to enhance your paper. You may wish to use some to seek clarification and elaboration of ideas and information presented in the course, some of which comes from these books. They may also be used to enhance and develop your ideas. For example there are elaborations on the different possibilities for a healthcare system in the U.S. Some of the optional sources may help you to find out more about those ideas that appeal particularly to you.
The sections to the paper will be assigned throughout the course. At the moment it looks like this:
Section#1: Why is healthcare seen by many persons in the U.S. as an important issue[3rd major issue in the last presidential election] ? And what is the perfect storm brewing? [This is the subject of my first lectures, so you will have a good idea of what is meant by this question and some possible answers.]
Section#2: Is there a right to healthcare by persons in the U.S.? I have deliberately chosen specific words, including the use of the word "person" rather than "citizen" [note that the 14th Amendment in the U.S. Constitution does likewise]. What is meant by terms like "right" and "healthcare" is part of the discussion. You should indicate some of answers to this question, and at the end provide a summary of your basic approach to answering this question.
Section#3: What are the institutional and political cultural factors to take into account in analyzing what it takes to produce and manage a national healthcare policy? You should add a comparative element to this section after we have discussed European systems. That is, why do all of them have national healthcare systems and we do not; and what institutional factors play into the politics of making major changes in healthcare systems?
Section#4: What lessons do we learn from the politics of Medicare and the failed politics of the Clinton proposal? Given these lessons, what political, cultural and economic elements are necessary if Pres. Obama is to bring his healthcare proposal into effect?
Section#5: What healthcare system appears to you as the best system and why? What healthcare system appears to be the most doable [even if it is not your first preference] given the political culture, present economic environment and the various political elements of concerning ranging from specific institutions such as the presidency to the financial power of interest groups? Be specific in your answers, drawing upon specific facts historically and at present.
BOOKS [required]:
Barr, Daniel. Introduction to U.S. Health Policy. 2nd ed.
Articles:
Excerpts from books and articles will be handed out in class.
Movies/Documentaries: Sicko by Michael Moore will be on reserve. I may place some others also, ----- The library has DVD players so that you can check out a video and watch it on the player in the library.
OPTIONAL Reading: I will be drawing upon these as well as many other sources for lecture material. If you desire to read any of them or sections from them they will be on reserve in the library.
Daniels, Norman. Just Health. This is one of the best developed books on a philosophical approach to the right of a person to health care. Daniels builds on the philosophy of John Rawls in setting forth his ideas.
Weissert, Carol S and William g. Weissert. Governing Health: The Politics of Health Policy . Basic information on U.S. Politics as well as healthcare policy can be found here. [There is a more recent edition, but this one suffices for good information, especially concerning the Clinton plan and the political problems it had].
Himmelstein, David, Steffie Woodhandler, Ida Hellander. Bleeding the Patient. This is a good book for a major version of the single-payer plan as it might apply to the U.S. and why it should be adopted. Note that the U.S. Medicare system is a single-payer type of program.
Theodoulou, Stella Z. Policy and Politics in Six Nations. This is a very short, but informative book, on various policies, including healthcare policies in several nations.
Cannon, Michael. Healthy Competition: What's Holding Back Health Care and How to Free It. This is published by the CATO Institute and presents the most private-oriented, market approach being discussed. It is at one end of the spectrum in terms of government involvement and the single-payer at the other end, although the latter does not need the full government administrative approach one finds in a fully government administered system such as the U.S. Veteran's Administration hospital system. Plans calling for reliance on tax incentives and private market solutions can draw on the arguments in this book.
Callahan, Daniel and Angela Wasunna. Medicine and the Market. This is one of the best books around. It compares Canada and the U.S. and speaks to the question as to whether the market holds the key to the future. The arguments throughout are well-balanced among the various positions, and the reliance on solid evidence appears to guide their conclusions.
Hackey, Robert B. and David Rochefort. The New Politics of State Health Policy. This contains an excellent set of chapters written by different authors and dealing with different state systems. Much can be learned about Medicaid, HMO's, state politics, and other aspects of efforts to experiment with different healthcare systems in political units smaller than the nation as a whole. The chapter on Oregon's efforts to reform Medicaid and how the various political actors were brought together is instructive not only of state political possibilities but also national. The program includes an attempt at rationing health care.
Oberlander, Jonathon. The Political Life of Medicare. Oberlander provides one of the best presentations of any of the books of the politics behind U.S. healthcare policy in his analysis of the politics of Medicare. Chapter 6 is especially significant. This book, along with the one by David Broder and Haynes Johnson, The System provide a wide array of insights into the practical politics of healthcare in the U.S. at the national level.
Broder, David and James Johnson. The System. A thorough treatment of the failed politics of the Clinton comprehensive healthcare plan. This holds the lessons for what not to do in pushing forth a comprehensive plan and what political obstacles are in the way. Obama's advisors need to read this book and Oberlander's above very carefully if they seek a comprehensive healthcare plan that succeeds through the turbulent political waters in the U.S.
Herzlinger, Regina. Market Driven Health Care. Herzlinger provides a market-oriented set of ideas but with the requirement that everyone in the nation has to have health care insurance. Although working within a libertarian think-tank, she is willing for the government to force purchase of health care by all in order for the market system to work.
Rhodes, Rosamond, Margaret Battin and Anita Silvers. Medicine and Social Justice. This contains numerous articles arguing for and against the notion of a right to healthcare as well as other issues seeking answers to what is justice in the system.
Relman, Arnold. A Second Opinion: Rescuing America's Health Care. Relman is the former editor-in-chief of the New England Journal of Medicine [one of the most prestigious medical journals in the U.S. and internationally]. He makes an argument for a variant of the single-payer system as a national, universal health care system.
POLICY STUDIES: There are numerous policy institutions that produce studies on healthcare. At the following link you can go to my list of sources and in the table click on "Policy Studies". The Commonwealth Foundation, Kaiser Foundation, RAND and several others are non-partisan and not linked to a particular ideological or philosophical approach. Those think tanks that are so linked are also good sources but need to be used carefully and with an eye to checking with other sources. I've tried to indicate wherever there seems to be a clear philosophical or ideological leaning of the institution and what it is. Go to http://www.stetson.edu/~gmaris/Resource.htm#Policy%20Studies.
|
DATE |
TOPICS
|
READINGS AND OTHER ASSIGNMENTS--Due on the date indicated -- |
|
1/13 |
Intro. You can avoid, or at least ignore, many issues in politics, but this is one you cannot personally afford to ignore.
|
|
| 1/15 |
Intro. |
Barr, pp. 1-19
|
|
1/20 |
Intro. |
Write a draft of Section# 1 of the course paper: one and
a half to two pages, font 10, single space, normal margins.
Send to Blackboard by midnight Jan. 19 Your draft will be evaluated as Excellent, OK or Weak. You can revise and improve for the final composite paper to be presented at the end of the course. Section#1: Why is healthcare seen by many persons in the U.S. as important [3rd major issue in the last presidential election] . And what is the perfect storm brewing? [This is the subject of my first lectures, so you will have a good idea of what is meant by this question and some possible answers.] |
| 1/22 |
Is There a Right to Healthcare? A Special Moral Status? A Legitimate Expectation in Our Political Culture? |
Barr, pp. 20-34 |
| 1/27 |
Is There a Right to Healthcare? A Special Moral Status? A Legitimate Expectation in Our Political Culture?
|
Barr, pp. 35-52
|
|
1/29 |
Historical Developments in the U.S. Healthcare System Politics and Healthcare: A review of key institutions and processes that affect the healthcare debate and developments [This is aimed especially at students not accustomed to some of the terminology and ideas used in discussing the U.S. political landscape and some of the forces at work in politics. As complicated as U.S. politics is, there are some basics that are easily learned and that operate in all the policy issues, including healthcare.] |
Write a draft of Section# 2 of the course paper: one and
a half to two pages, font 10, single space, normal margins.
Send to Blackboard by midnight Jan. 28 Your draft will be evaluated as Excellent, OK or Weak. You can revise and improve for the final composite paper to be presented at the end of the course. Section#2: Is there a right to healthcare by persons in the U.S.? I have deliberately chosen specific words, including the use of the word "person" rather than "citizen" [note that the 14th Amendment in the U.S. Constitution does likewise]. What is meant by terms like "right" and "healthcare" is part of the discussion. You should indicate some of answers to this question, and at the end provide a summary of your basic approach to answering this question. |
| 2/3 |
Politics and Healthcare: A review of key institutions and processes that affect the healthcare debate and developments [This is aimed especially for students not accustomed to some of the terminology and ideas used in discussing the U.S. political landscape and some of the forces at work in politics. As complicated as U.S. politics is, there are some basics that are easily learned and operate in all the policy issues, including healthcare.] The Politics Behind Medicare [Oberlander's book above in the optional reading will be the source for my lecture on this. His chapter 6 on explanations and theories is especially revealing and important. You are not required to read it but may wish to do so.] |
View Michael Moore's documentary "Sicko". It is on reserve in the
library and can be viewed there. Be prepared to discuss what appears
to be propaganda and what is solid information, what might be useful
politically and what might not be, what facts seem to be supported and which
ones need some careful checking. There are numerous commentaries
online both pro and con if you wish to view some them. If you do, look at
both sides.
|
|
2/5/08 |
Politics continued.
|
Write a draft of Section# 3 of the course paper: one and
a half to two pages, font 10, single space, normal margins.
Send to Blackboard by midnight Feb. 4. Your draft will be evaluated as Excellent, OK or Weak. You can revise and improve for the final composite paper to be presented at the end of the course. Section#3: What are the institutional and political cultural factors to take into account in analyzing what it takes to produce and manage a national healthcare policy? You should add a comparative element to this section after we have discussed European systems. That is, why do all of them have national healthcare systems and we do not; and what institutional factors play into the politics of making major changes in healthcare systems? |
|
2/10 |
Politics continued.
The Politics behind the Clinton Comprehensive Healthcare Plan |
Hand-out: Broder and Johnson, sections from The System. |
| 2/12 | Politics continued. |
Write a draft of Section# 4 of the course paper: one and
a half to two pages, font 10, single space, normal margins.
Send to Blackboard by midnight Feb. 11. Your draft will be evaluated as Excellent, OK or Weak. You can revise and improve for the final composite paper to be presented at the end of the course. Section#4: What lessons do we learn from the politics of Medicare and the failed politics of the Clinton proposal? Given these lessons, what political, cultural and economic elements are necessary if Pres. Obama is to bring his healthcare proposal into effect? |
| 2/17 | EXAM | |
| 2/19 |
Healthcare
Systems -- Private-oriented
Managed Care |
Barr, pp. 79-97
|
|
2/24 |
Healthcare Systems -- Private-oriented
|
Barr, pp. 98-112
|
| 2/26 |
Prescription
Drugs -- Can't Live Without Them? Can't Afford to Live With Them? -- Corporate
Power in the Political Equation |
Barr, pp. 186-210 |
| 3/10 |
U.S. Government Healthcare System -- Medicare |
Barr, pp. 113-144
|
|
3/12 |
U.S. Government Healthcare System: ---various governmental systems |
|
| 3/17 |
U.S. Government
Healthcare System -- Medicaid/SCHIP
|
Barr, pp. 144-165 |
|
3/19 |
National Healthcare Systems --- Other Countries Britain: National Socialized Healthcare |
PBS Film: National Healthcare Systems |
| 3/24 |
National Healthcare
Systems --- Other Countries
Germany: National Social Insurance Healthcare |
Hand-out: Blank, Comparative Health Care Policy, chps. 3,4. |
| 3/26 |
National Healthcare
Systems --- Other Countries
Sweden: Centralized and Decentralized |
|
| 3/31 | EXAM | |
| 4/2 |
Access to Healthcare: Who Gets What, When and How? [a twist on Harold
Lasswell's famous pithy definition of politics] |
Barr, pp. 224-238 |
| 4/7 |
The End Results --- The Proof is in the Pudding, Especially at a Cost of Over a Trillion Dollars a Year. How Do We Know Success When We See It? |
Barr, pp. 239-257 |
| 4/ 9 |
A Multitude of Reform Proposals |
|
| 4/14 |
Single-Payer Plan |
Hand-out: Physicians' Plan on Single-Payer System. |
| 4/16 | Market-Oriented Plan | Hand-out: Callahan chapter and chapter from Herzlinger's book. [These will probably take the week to read. Read as much as possible prior to 4/16 and the rest by 4/21.] |
| 4/21 | Federal Employees Plan as Model? | |
| 4/23 | Your Choice of Plans |
Write a draft of Section# 5 of the course paper: one and
a half to two pages, font 10, single space, normal margins.
Send to Blackboard by midnight April 22. Your draft will be evaluated as Excellent, OK or Weak. You can revise and improve for the final composite paper to be presented at the end of the course. Section#5: What healthcare system appears to you as the best system and why? What healthcare system appears to be the most doable given the political culture, present economic environment and the various political elements of concerning ranging from specific institutions such as the presidency to the financial power of interest groups? Be specific in your answers, drawing upon specific facts historically and at present.
|
| 4/28 | TBA |
Your last section [#5]will be returned by Saturday night/Sunday morning. [April 25/26] --- Your final paper with revisions and polished is due by Wed. April 29 midnight. |
Grading:
Mid-Term Exam: 20%
Mid-Term Exam: 20%
Course Paper: 20%
Final Exam: 40%
Attendance is expected on a regular basis. More than 3 absences work against the final course grade. The more absences one incurs, the more impact there is on the final grade.