AMERICAN HEALTH CARE: POLICY AND POLITICS

PLCY 361, section 001 Professor Joel J. Schwartz
Smith Hall Room 107 MWF 11:00am - 11:50am
joel_schwartz@unc.edu
942-2897 (home)

Office Hours - to be arranged
Abernathy Hall 109
Also by appointment.

I. Course Description

This course focuses on issues and political dynamics in American medical care. My goal is to help you prepare yourself as a future health professional or to assist you to think systematically about contemporary problems in health policy so as to be able to participate in the national debate over health care reform. Each class will focus on one of the course topics listed below.

II. Course Objectives

You should acquire a well-informed, evidence-based understanding of the strengths and weaknesses of medical care in the United States.
You should be able to read critically and to evaluate the on-going national debate about reforming and improving the organization, delivery, and financing of medical services in the United States.

III. Assigned Readings
1. Paul Starr, The Social Life of American Medicine
2. Jonathan Cohn, Sick

3. T. R. Reid, The Healing of America

IV. Course Topics

1. How and Why Did Our Unique Health Insurance System Evolve in the Twentieth Century?
2. The Attrition of Employer-Provided Health Insurance Coverage
3. The Continuous Rise in the Numbers of Medically Uninsured and Underinsured
4. Public Health Insurance, Public Medical Care Facilities and the Emergence of a Three-Tiered Health Care System
5. The Budgetary Pressures on Public Medical Care Costs and Their Impact upon the Medical Safety Net of Last Resort
6. The Implicit Rationing of Medical Care Resources: Who Decides Which Patients Receive How Much of What Kind of Care and for How Long
7. The Efforts to Contain Escalating Health Care Costs: Many Theories in a Search for Reality
8. Who Should Decide When and How Life Ends?
9. Why Is the United States the Only Developed Nation in the World That Does Not Regulate the Price of Prescription Drugs? What Are the Consequences?
10. The Medical Technology Arms Race: Create It and Providers Will Use It.
11. Why Is Demand for Medical Services an Inelastic Demand?
12. Why Is the Disparity Between the Kinds and Locations of Medical Providers and the Distribution and Types of Specialties So Great?
13. How Efforts to Rationalize Utilization of Health Care Resources Failed
14. Is There Really a Malpractice Crisis?
15. What Can We Learn from Other Nations such as Canada and Gt. Britain About Alternative Ways To Organize, Deliver, and Finance Medical Care Services?

V. Course Requirements and Exams

There will be two exams plus a final exam. Your take-home exam should not exceed seven double-spaced, size 12 font, typed pages. Each exam will cover the assigned readings. documentaries and class discussions to that point in the semester. Each exam will count 1/3 of your course grade.

VI. Policy Regarding Requests for Extensions

I understand that sometimes unanticipated events occur and you may wish to request an extension. If this happens, you MUST email me or TALK to me BEFORE the assignment is due. This includes the submission of exams and position or reaction papers. Failure to receive permission for an extension from me will be treated as non-submission of a required paper or exam. Also requests for extensions for other than medical or family reasons may result in a penalty of one exam grade.

VII. Position Papers

I will periodically assign ungraded position papers. These papers should be a maximum of 2 typed pages each. There are no right or wrong answers to these questions; I want to know what you think about these issues and in order to ensure free expression of views, you will not be graded on these papers, though they are mandatory.

VIII. Grade Appeal Policy

I take the evaluation and grading of your exams very seriously because I know that you take the preparation and writing of your exams very seriously. In arriving at a grade for a particular essay, I use what is referred to as peer reference norm grading. I compare your essay to those essays that I believe represent excellence, both in the content and the presentation of that content. A copy of that essay is given to you when your paper is returned. If you are unhappy with your grade and feel an academic injustice has been done, you should do the following:

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1. Read the comments at the end of your essay which explain why you received the grade on your paper and reread your essay with these comments in mind.
2. Read the attached anonymous essay and compare it to your own essay.
3. If you have completed the above steps, but still want your exam to be reread, write a maximum one page explanation of why you feel your exam deserves a higher grade; attach it to your essay, and give a copy to me at the beginning or end of class.
4. Allow at least a 2-class interval for me to reread your exam and explanation and then come see me during office hours or by appointment. !

IX. Class Attendance and Class Participation

I consider a course to be a social contract between the instructor and the students. As an instructor, my responsibility is to do everything possible to make each class meeting an optimal learning experience. As students, your responsibility is to be present at every class meeting and to be prepared to participate actively in class. You will be asked to share views and thoughts that you have had time to think about in advance or have had an opportunity to organize in writing. Each student will be called upon to contribute to the learning process. No one will be allowed the luxury of passive anonymity. If you feel that you are unable or unwilling to be present at every class meeting, (except for compelling and verifiable reasons) or are unable or unwilling to actively contribute to class discussions, you should drop this course immediately. Students who chronically miss class will be penalized two course letter grades. If you wish clarification of anything that you read, hear in class, or see in a documentary, but do not wish to publicly ask a question, write out your question, leave it on the desk at the end of class and I will respond to it the following class session. Alternatively, you may email me the question and I will respond to you.

Hints for Writing an Excellent Essay

1. Read the question carefully and answer what is asked. Do not revise or reinterpret the question.
2. Do not waste space by restating in the opening and closing paragraphs of your essay the question asked. Begin your argument immediately.
3. Avoid redundancy and making the same point over and over again. State your point once in clear and concise language and move onto the next point.
4. Do not write long, awkward sentences.
5. Pay attention to paragraphs and smooth transitions. Do not write 2-3 page paragraphs. Start a new paragraph when you start a new part of your argument.
6. Make sure the vocabulary that you use is appropriate and states correctly what you want to say.
7. Do a spelling check to ensure that all words are spelled correctly.
8. Carefully proofread your final draft to ensure that there are no typographical errors.