Health Policy and the Transformation of American
Medicine
Fall 2002
Tuesday 2:30-4:30 PM
Jon
Oberlander, PhD
Department of Social Medicine
Office: Wing D, Room 372
Phone: 843-8269 (o), 968-8942 (h)
Email: oberland@med.unc.edu
Website: : http://www.unc.edu/~oberland
(best viewed
in Internet explorer)
Seminar
Description
This seminar explores issues, trends, and
controversies in American health policy. This is a turbulent period in the
health care system, with rising costs, growing ranks of uninsured Americans,
and increasing dissatisfaction with managed care. We will study how the U.S.
health care system got into this predicament, the rise (and demise?) of managed
care, the role of public programs Medicare and Medicaid in health policy, and
emerging issues in health reform.
Seminar objectives
This seminar is intended to prepare students to
participate knowledgeably in health policy debates as members of the medical
profession and as citizens in the political system. In particular, I hope that
by the end of the course you will come away with a better understanding of:
1.The history of
American health policy and how that history has shaped the current medical care
system.
2.The politics of
health care reform and how American political institutions, ideology, and
interests have impacted the substance and process of health policymaking in
this country.
3.International health
systems and the differences between these systems (such as Canada’s
single-payer model) and the American approach.
4.The rise and fall of
managed care.
5.Policy issues in
Medicare and Medicaid.
6.Emerging issues,
including prescription drug costs and long-term care.
The primary requirement of the seminar is
participation. You will spend much of your medical school career in vast
auditoriums trying to figure out why the professor is running through his/her
slides at supersonic speeds. We have a very different learning environment here
and its success depends on your engagement with course issues and active
participation in seminar discussions.
These discussions will revolve around course readings, and
it is critical that you read and reflect on these selections before each class.
You should focus on the main concepts and arguments in each article, and not
get bogged down in the endless details, facts, and figures we will encounter.
For course sessions with longer readings, we will divide up
the reading load with each half of the class responsible for a different
section of that week’s assignment.
Some readings can be read on-line and the links
are in the syllabus. The syllabus is posted on my web-site(http://www.unc.edu/~oberland ) and
linked readings can be accessed there.
There will be 2 papers (each
around 5-7 pages in length) that ask you to analyze specific issues or
controversies in health policy. Your papers should be thoughtfully written and
argued, carefully edited, and well-organized. They will be graded on the basis
of substantive content, research effort, and writing quality. We will pick the
due dates during the first class meeting so they fit with the rest of the
schedule. The first paper will also be assigned at the beginning of the
semester to give you as much time as possible to research and write.
Course grades will be determined as follows:
Class
participation 40%
Paper 60%
Attendance at all seminar
sessions is mandatory and absenteeism will result in a failing grade.
Late papers will be penalized. We all encounter life
problems that may interfere with our ability to function. If such a problem
arises, you can receive an extension if you notify me before the paper is
due.
Schedule
of sessions
August
20 Introduction:
Issues in U.S. Health Care Policy
Begin next
week’s reading from Paul Starr, “The Mirage of Reform.” This reading is
on reserve in the Health Sciences Library. This is a long selection and
the intent is for you to read it over 2 weeks.
August
27 The Political History of National Health Insurance
Paul Starr, 1982.The
Social Transformation of American Medicine (Basic: New York).Chapter 1,
Book 2, “The Mirage of Reform,” 235-256, 267-289.On reserve in Health
Sciences Library.
September
3 The Politics of Health Reform: The Clinton
Health Plan
Walter Zelman,
1994."The Rationale Behind the Clinton
Reform Plan," Health Affairs 13: 9-29.
Paul Starr,
1995."What Happened to Health Care Reform?, American
Prospect
http://www.prospect.org/print/V6/20/starr-p.html
September
10 International
Comparisons I: The Canadian Health System
David Naylor,
1999.“Health Care in Canada:
Incrementalism Under Fiscal Duress,”
Health Affairs 18(3): 9-24.
September
17 International
Comparisons II: Looking Beyond Canada
Video, Borderline
Medicine
Joseph White, 1995.Competing
Solutions: American Health Care Proposals and International Experience
(Washington: Brookings Institution Press): 128-162.
September 24 HMOs and Competition
Jon Gabel,
1997.“Marketwatch: 10 Ways HMOs Have Changed During the 1990s,”
Health Affairs 16 (3): 134-45.
Robert Kuttner, 1998.“Must Good HMOs Go Bad?,”
New England Journal of Medicine 338(21):
1558-63
October
15 Physicians
and Managed Care
Video, Dr.
Solomon’s Dilemma
Uwe Reinhardt, 1999.“The Predictable Managed Care
Kvetch on the Rocky Road from Adolescence to Adulthood,”
Journal of Health Politics, Policy and Law 24(5): 897-910.
Deborah
Stone, 1997."Bedside Manna," The American Prospect 8(31):
March/April/ http://www.prospect.org/print/V8/31/stone-d.html
October
22 Medicare
Jon Oberlander, 2002.“Medicare: The End of Consensus,” Handout.
Kaiser Family
Foundation, 2001.Medicare at a Glance.
http://kff.org/content/archive/1066/Medicare%201066.pdf
October
29 Prescription
Drugs
John Iglehart, 2001.“Medicare and Prescription Drugs.” New
England Journal
of
Medicine 344(13):1010?1015.
LD Chew et al.,
2000.“A physician survey of the effect of drug sample availability on
physicians' behavior.” Journal of General Internal Medicine 15: 478-483.http://www.nofreelunch.org/required.htm
Kaiser Family
Foundation, 2001.Prescription Drug Trends Chartbook
http://www.kff.org/content/2001/3112/RxChartbook.pdf
November 5 Medicaid and
Long-Term Care
John Iglehart, 1999.“The American Health Care System–Medicaid.”New England Journal of
Medicine 340(5): 403-408.
Kaiser Family
Foundation, 1999.Long Term Care: Medicaid’s Role
and Challenges. http://kff.org/content/2000/2172/LongTermCare.pdf
November
12 What’s Next for American Health Policy–The Insured and Uninsured
James Robinson,
2001.“The End of Managed Care.” Journalof
the American Medical Association 285(20):2622?2628.