Hsp 154H, Section 2, Great Issues in Social Science

HSP 154H, SECTION 2, GREAT ISSUES IN SOCIAL SCIENCE:

U.S. and International Health Policy

Fall Semester 2012

Class meets Mondays and Wednesdays, 2:15 - 4:05 PM; Norris 104

Faculty

Al Pheley, Ph.D. Greg Saltzman, Ph.D.

Office: 201 Robinson Hall Office: 101 Robinson Hall

Phone: (517) 629-0359 Phone: (517) 629-0422

Home: (517) 630-0442 Home: (734) 971-7596 (not after 9:30 PM)

E-mail: -mail:

Office Hours: T,TH10-11 AM; 1-2PM Office Hours: MTuWTh 10-11 AM

or by appointment or by appointment

Both of us are happy to talk with students at times other than our official office hours. If either of our doors is open, then feel free to stop in. Dr. Pheley is generally on campus 7:45 AM to 5 PM, Monday through Friday. Dr. Saltzman is generally on campus 9:35 AM to 4:15 PM Monday through Thursday (but is usually not at Albion on Fridays).

If you prefer, you can make an appointment with either of us by calling or e-mailing us. Students may also call Ann Garrett (x0368) to set up an appointment with Dr. Pheley.

Assigned book: T. R. Reid, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care (Penguin, 2010 paperback edition with update on 2010 Obama health insurance law), ISBN-13: 978-0143118213.

CourseWeb:

Log in with your username and password, then choose HSP 154 from the left side. Readings other than the Reid book are available on the course web via PDF files or URLs.

Purpose and Objectives

This course is designed to give students in Albion‘s Honors Institute direct exposure to social science scholarship. Students will read research or policy articles in academic journals, rather than digested versions available from textbooks. We have done our best to assign articles that are accessible to smart students with little or no previous background in health policy or social science; but the challenge of wrestling with genuine scholarly journal articles is an inherent part of this Honors course. Article authors include scholars in medicine, public health, economics, political science, sociology, or psychology.

This Honors course compares health policy in the U.S. and other wealthy democracies. It addresses contemporary issues related to health insurance, public health problems that require behavioral changes and not just medical treatment, and racial and social class disparities in health outcomes.

Insurance

While the U.S. is in many ways similar to other wealthy democracies, America has a distinctive health insurance system. How does the health insurance system affect access to health care, cost, and health outcomes? The assigned book by T. R. Reid describes the health insurance systems in France, Germany, Japan, Britain, Canada, and Taiwan and the extent to which they might serve as a model for the U.S. Scholarly journal articles on the course web for HMP 154 analyze the impact of health insurance and the likely consequences of the 2010 Obama health insurance law, the Affordable Care Act.

Health-Related Behaviors

Obesity, smoking, lack of exercise, excessive alcohol consumption, and sexually transmitted diseases have significant adverse effects on health. Medical treatment can help mitigate these adverse effects, but behavioral changes are needed to prevent illness. Many see births to teenage mothers as a social problem and advocate behavioral changes in this domain as well. What policies have the U.S. and other countries adopted to address public health challenges such as these?

Racial, Social Class, and Geographic Disparities

In the U.S., blacks have substantially shorter life expectancies than whites. To what extent does this disparity stem from:

• The health insurance system?
• Genetic differences, lifestyle, or attitudes towards medical treatment?
• Racial discrimination by health providers?
• Social class differences in housing, employment conditions, and exposure to environmental hazards?

To what extent do social class disparities in life expectancy and morbidity persist even in nations such as Britain with national health insurance? To what extent are there geographic disparities within nations in access to health care, and what can be done to improve access for those in rural areas?

Learning Objectives of This Course

• Describe the major current debates in health policy including access to health care as a right or privilege and cost control.

• Compare and contrast the U.S. health care system and those in other wealthy democracies.

• Analyze contemporary debates in the U.S. over whether the 2010 Obama health law should be repealed and whether Michigan and other states should accept federal funds provided by that law to expand Medicaid, a federal-state health insurance program for the poor.

• Discuss the issues of public health and health disparities as they relate to health care reform.

• Synthesize information and develop and defend a health policy proposal.

• Demonstrate clear, concise, and persuasive writing and oral presentation skills.

• Demonstrate independent ability to identify and interpret relevant scholarly literature

Grading and Course Requirements

This is an Honors Institute class. Hence, we expect and strongly encourage advance preparation, critical thought, good writing, and consistent, thoughtful discussion. Individual contributions to the class and team project are highly valued and reflected in the final grade.

Class Participation

We expect you to have read the assigned readings for each class and to participate in discussion of those readings. We also want you occasionally to bring in articles from the popular press about current issues related to health policy, which the class can discuss.

Student-led Discussion Assignment

Each student will lead the discussion of two articles during the course of the semester, one in October and one in November. Although we expect all students to do the assigned readings and be prepared to discuss them in class, the discussion leader for a particular reading assumes additional responsibility. First, the discussion leader should read the article well in advance of the day it is discussed in class and, if necessary, see Al Pheley or Greg Saltzman to ask about parts of the article that are difficult to understand. Second, the discussion leader will explain difficult portions of the article to her or his classmates (though you need not worry about the statistical methodology used in some of the articles). Third, the discussion leader should prepare a list of questions to prompt participation by other students in the discussion of this article.

Thirty-six articles for student-led discussion (2 for each student in this class, plus four extras) appear after the heading, "Student led paper discussion." Al Pheley or Greg Saltzman will lead the discussion for articles not appearing after such a heading.

Group Project: Health Policy Proposal

Working in groups of four, students will develop and present a public policy proposal on a current health-related issue that each group selects, in consultation with Al Pheley and Greg Saltzman. You are required to articulate and justify your proposal in a group paper (due December 3) and in a group PowerPoint presentation (given either December 3 or 5). Details of the group project assignment will be provided in a separate document.

For some articles on current health policy issues, see this web site operated by the New England Journal of Medicine: The Albion College library also has online subscriptions to the New England Journal of Medicine, JAMA(theJournal of the American Medical Association),American Journal of Public Health, Health Affairs, and other sources related to health policy.

Short Position Papers

Each student will write two short position papers.

• For the first paper, due September 24, you are to take a stand either in support of, or against, the rationing of health care.
• For the second paper, due October 24, you are to take a stand either in support of, or against, a recent proposal by Mayor Michael Bloomberg of New York to ban the sale of sugary drinks in sizes larger than 16 ounces.

Extensive readings are provided on the course web for the September 24 paper. Some readings are provided on the course web for the October 24 paper; see both the readings for October 24 and the Camereret al. article assigned for November 5. We will, however, expect you to find some of your own sources for your October 24 paper. Details of the short position paper assignments will be provided in separate documents.

Attendance Policy

Regular participation in class activities is critical to the individual‘s understanding of the material covered during class discussions and to the success of the group projects. As such, students are expected to attend class and participate fully in class discussions. All individuals are expected to participate equally and equitably in the group project – meaning that group members may receive different participation grades based on their level of involvement. The decision to attend class, and the level at which you participate, is up to you. Students are expected to make up any work that is missed for any reason.

Academic Integrity

Albion College has adopted the following statement on academic integrity: “As an academic community, Albion College is firmly committed to honor and integrity in the pursuit of knowledge. Therefore, as a member of this academic community, each student acknowledges responsibility for his or her actions and commits to the highest standards of integrity. In doing so, each student makes a covenant with the college not to engage in any form of academic dishonesty, fraud, cheating, or theft.”

We expect you to cite your sources for ideas presented in your papers. We expect you to include quotation marks and provide a citation if you use somebody else‘s words in your papers.

Disability Statement

If you have a disability and may require accommodations or modifications in class instruction or course-related activities, please contact the Learning Support Center (LSC) staff who can arrange for reasonable accommodations for students who provide documentation of their disability or condition. If you are presently registered with the LSC and have requested accommodations through the LSC for this semester, please plan to meet with one of the instructors as early as possible to discuss the best way to implement these accommodations in this class. The LSC is located on the third floor of the Seeley Mudd library; their phone number is 517-629-0825.

Tentative Class Schedule and Readings

Week 1(a) What is health?

(b) Health care vs. health

Monday, August 27, 2012

- Class Introduction

- What is health?

• World Health Organization. WHO definition of health. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

• Jadad AR, O‘Gradey L. How should health be defined? British Medical Journal.2008;337:1363-1364.

• Sarracci R. The World Health Organization needs to reconsider its definition of health. British Medical Journal.1997;314:1409-1410.

• Koplan JP, Bond TC, Marson MH., etal. Towards a common definition of global health. Lancet. 2009;373:1993-1995.

Wednesday, August 29, 2012

- Health care and other determinants of health

• McGinnis JM, Williams-Russo P, and Knickman JR. The case for more active policy attention to health promotion. Health Affairs.2002; 21: 78-93.
• Case A and Paxson C. Parental Behavior and Child Health. Health Affairs. 2002; 21: 164-178.
• Marmot M. The influence of income on health: Views of an epidemiologist. Health Affairs.2002; 21: 31-46.
• Teutsch SM, Baciu AB, Mays GP, et al. Wiser Investment for a Healthier Future. Journal of Public Health Management Practice. 2012; 18: 295–298.

Week 2Is health care a right?

Monday, September 3, 2012:No classes (Labor Day)

Wednesday, September 5, 2012:

- Access to care - a right or a privilege?

• Carmalt J, Zaidi S. The right to health care in the United States of America. What does it mean? Center for Economic and Social Rights. October, 2004.

• Peikoff L. Healthcare is not a right. Delivered under the auspices of Americans for Free Choice in Medicine ( at a Town Hall Meeting on the Clinton Health Plan on December 11, 1993

• McDermott J. Healthcare must be a right, not a privilege. September 26, 2007.

• Montanaro D. Is health care a ‘privilege’ for some? MSNBC. March 5, 2009.

• Harmon H. Health care is a right, or is it? Gather. August 5, 2009.

• Ponnuru R. Health care as a right. National Review Online. August 3, 2009.

• Sanders B. Health care is a right, not a privilege. The Huffington Post. June 8, 2009.

• Murphy WF. Statement for the Record.Roundtable Discussion on Expanding Health Care Coverage.United States Conference of Catholic Bishops. May 20, 2009.

• Orsi M. Bishops wrong: Health care not a right. HumanEvents.org.July 30, 2009.

Week 3Overview of U.S. health care system

Monday,, September 10, 2012

- The U.S. Health Care System – a Brief Overview

• Chua KP. Overview of the U.S. health care system.American Medical Student Association. February 10, 2006.

•Jaouad S. A reluctant crash course in health insurance 101. The New York Times. August 21, 2012: D5.

• Fuchs VR. Health Care Reform: A Collection of Articles on U.S. Health Care Reform (Robert Wood Johnson Foundation, 2010), pp. 2-3, 6-8, and 21-26.

• Lyke B. Health care reform: An introduction. Congressional Research Service. April 14, 2009.

•Gawande A. The Cost Conumdrum. The New Yorker. June 1, 2009.

•Gawande A. Big Med. The New Yorker. August 13, 2012: 52-63.

Wednesday, September 12, 2012

- Extending Insurance Coverage in the U.S.

• Blumenthal D, Morone J. The lessons of success: Revisiting the Medicare story. New England Journal of Medicine.2008;359:2384-2389.

• Brook RH. The science of health care reform.JAMA. 2009;301:2486-2487.

• National Coalition on Health Care. Insurance. National Coalition on Health Care.

• History of the Obama Health Law. The New York Times. June 28, 2012.

Week 4(a) Making choices in health care reform

(b) A global view

Monday, September 17, 2012

- Health System Reform Simulation – the CHAT game

• Start reading T. R. Reid, The Healing of America

Wednesday, September 19, 2012

- A Global Perspective: France, Germany, Japan, and Britain

• T. R. Reid, The Healing of America, pp. 1-125.

Week 5(a) Health care rationing

(b) Canadian health care

Monday, September 24, 2012

- Health care rationing and the 1989 Oregon Medicaid plan

* SHORT POSITION PAPER 1 DUE SEPTEMBER 24 BY 2:00 PM*

General readings on health-care rationing:

• Reinhardt UE. ‘Rationing’ health care: What does it mean? The New York Times,Economix. July 3, 2009.
• Meltzer DO and Detsky AS. The Real Meaning of Rationing. JAMA. 2010; 304: 2292-2293.
• Ferrarra P. Obama Promises to Ration Your Care. National Review Online. July 23, 2009.
• Singer P, Why We Must Ration Health Care. The New York Times Magazine, July 19, 2009.
• Nix K. Comparative Effectiveness Research Under Obamacare: A Slippery Slope to Health Care Rationing. The Heritage Foundation, Backgrounder No. 2679. April 12, 2012.

• Bloche MG, Beyond the ‘R” Word? Medicine’s New Frugality. New England Journal of Medicine. 2012; 366: 1951-1953.
• Brody H, From an Ethics of Rationing to an Ethics of Waste Avoidance. New England Journal of Medicine. 2012; 366: 1949-1951.
• Fuchs VR. The Doctor’s Dilemma – What Is ‘Appropriate’ Care? New England Journal of Medicine. 2012; 365: 585-587.
• Neumann PJ and Weinstein MC. Legislating against Use of Cost-Effectiveness Information. New England Journal of Medicine. 2010; 363: 1495-1497.
• Brook RH. The Role of Physicians in Controlling Medical Care Costs and Reducing Waste. JAMA. 2011; 306: 650-651.

Readings on 1989 Oregon Medicaid plan:

• Saha S, Coffman DD, and Smits AK. Giving Teeth to Comparative-Effectiveness Research – The Oregon Experience. New England Journal of Medicine. 2010; 362: e18(1)-e18(3).

• Oregon Department of Health and Human Services, Office of Medicaid Assistance Programs. Oregon health plan: An historical overview. June, 2006.
• Gorman L. Rationing care: Oregon changes its priorities. Brief Analysis No. 645. National Center for Policy Analysis. February 19, 2009.
• Oberlander J, Marmor T, Jacobs L. Rationing medical care: Rhetoric and reality in the Oregon Health Plan. Canadian Medical Association Journal. 2001;164:1583-1587.
• Klein R. On the Oregon trail: rationing in health care. British Medical Journal. 1991;302:1-2.

Wednesday, September 26, 2012

- Health care in Canada, part I

• T. R. Reid, The Healing of America, pp. 126-142.

Week 6So, what’s health care like up der in da north, eh?

Monday, October 1, 2012

- Health care in Canada, part II

• Iglehart JK. Revisiting the Canadian Health Care System. New England Journal of Medicine.2000; 342: 2007-2012.

• Eisenberg MJ. An American Physician in the Canadian Health Care System.Archives of Internal Medicine.2006; 166: 281-282.

• Sessions SY, Detsky AS. Washington, Ottawa, and Health Care Reform: A Tale of 2 Capitals. JAMA. 2010;303: 2078-2079.

• Ross JS, Detsky AS. Comparison of the U.S. and Canadian health care systems: A tale of two Mt. Sinai’s. JAMA. 2008;300:1934-1936.

• Flood CM. Is the Canadian System Right for the United States? Journal of Health Politics, Policy and Law.2009; 34:585-592.

Wednesday, October 3, 2012

- Canada’s single-payer system: a model for the U.S.?

*STUDENT LED PAPER DISCUSSIONS*

• Newell AR, Saltzman GM. Impact of reimbursement systems on child psychiatrists. A comparison of Canada and United States.Journal of the Academy of Child and Adolescent Psychiatry.1995;34:1326-1335. [Presenter: Student 1]

• The Physicians’ Working Group for a Single-Payer National Health Insurance. Proposal of the Physicians’ Working Group for a Single-Payer National Health Insurance.JAMA. 2003;290:798-805.[Presenter: Student 2]

• Stone D. Single Payer – Good Metaphor, Bad Politics. Journal of Health Politics, Policy and Law.2009; 34: 531-542. [Presenter: Student 3]

• Sullivan, K. Comment on Deborah Stone’s “Single Payer – Good Metaphor, Bad Politics.” JHPPL. 2010; 35: 277-288.[Presenter: Student 4]

Week 7More global perspectives on health reform in the U.S.

Monday, October 8, 2012

• T. R. Reid, The Healing of America, pp. 143-268.

Wednesday, October 10, 2012

*STUDENT LED PAPER DISCUSSIONS*

• Schoen C, Osborn R, Huynh PT, et al. Taking the pulse of health care systems: Experiences of patients with health problems in six countries. Health Affairs. 2005;W5:509-525. [Presenter: Student 5]