Norman J. Arnold School of Public Health

Department of Health Administration

HADM 711:

HEALTH POLITICS

Course Syllabus, Fall 2001

Time: Wednesday 8:30 A.M. - 11:00 A.M. (218A HESC)

Instructor: Michael E. Samuels, Dr.P.H.

Office: 116 HESC

Office Hours: Tuesday & Wednesday - 11:00 A. M. - 12:00 Noon

Telephone: 777-7417 E-mail: msamuels@sph.sc.edu

Course Content: The purpose of this course is to provide the student of public health a clear understanding of health politics as a key component of the environment in which the health care administrator must function. In the historical, social, economic, and political context that the U.S. health care system evolved are lessons and understandings that are necessary for this generation of health administrators and health policy makers to advance health for all. The course will provide an understanding of the structure of the political process in the health policy making. The political roles of the legislative, executive and judicial branches of government in health policy will be examined, as well as political roles that selected health professionals assume in the community. Major actors in health care policy development are identified within the context of the forces and institutions that they react to in shaping health care policy. The course will provide practical mechanisms to intervene on behalf of programs or institutions.

Course Objectives:

Upon successful completion of the course the student will:

(1) Understand the structure of the political process in the health policymaking process in the United States at the State and Federal level.

(2) Be familiar with the political roles of the legislative, executive and judicial branches of government relative to health policy.

(3) Be familiar with the political role that selected health professionals assume in the community.

(4) Be able to identify and classify the major and minor forces and institutions that shape health care policy.

(5) Understand the steps in the health policy process and how they as administrators may intervene on behalf of their program or institution.

TEXTS:

U.S. Senate, How Our Laws Are Made, Document No 12, 102D Congress, First Session.

The Instructor will make the Senate Document available. There will also be assigned journal articles. The assigned journal articles are available at Universal Copies at 1120 College Street.

Course Conduct:

The course will be conducted as a seminar with lectures provided by the instructor. Lectures and discussion will be based on the assigned readings. When possible, guest participants from the Columbia health professional community will be invited to provide personal insight into the topic under discussion (e.g. - J. Randall Lee III, President of the South Carolina Health Association will discuss the politics of Long Term Care in South Carolina). Student comprehension of the course material will be demonstrated by student presentations that analyze assigned readings on a particular health topic, a mid-term examination, and a major paper or annotated bibliography. The mid-term examination will be in essay form (3-5 questions) covering lectures and reading assignments. It will be handed out at the end of class on October 10th and is to be turned in prior to class on October 31st. The topic for the major paper or annotated bibliography should be approved as early in the semester as possible. Although not required students may submit an outline for critique and guidance. The major paper or annotated bibliography is due on December 12th.

Course Requirements Include:

- Completing all reading assignments

- Classroom participation including discussion leadership

- A mid-term examination (take home)

- Student presentation on assigned readings.

- A major research paper or annotated bibliography with a short summary.

There is no page requirement on the research paper or bibliography. The emphasis will be on quality research of narrow scope drawing on large numbers of source articles or in an extensive annotated bibliography.

GRADES will be computed as follows:

CLASS 1 - INTRODUTION AND ORIENTATION

August 29

ASSIGNED READINGS:

CLASS 2 - THE PROCESS OF GOVERNMENT

September 5

Class Objective: Student will understand the functioning of national government relative to health policy.

Assigned Readings:

Stevens, Rosemary, "Can the Government Govern? Lessons from the Formation of the Veterans Administration, Journal of Health, Politics, Policy and Law, Vol. 16, No. 2, Summer 1991, pp. 281-305.

Tierney, John T., "Organized Interests in Health Politics and Policy Making", Medical Care Review, 44:1 (Spring 1987), pp. 89-118.

Derrick, Frederick W., Scott, Charles E., "National Health Insurance: Lessons from the United States Experiment", Health Care Manage Rev, 1995, 20(3), 55-63.

CLASS 3 - THE PROCESS OF GOVERNMENT

September 12

Class Objective: Student will understand the functioning of national government relative to health policy.

Assigned Readings:

How Our Laws Are Made, pp. 1-50.

Rothman, David J., "A Century of Failure: Health Care Reform in America", Journal of Health, Politics, Policy and Law, Vol. 18, No. 2, Summer 1993, pp. 271-286.

Steinmo, Sven, Watts, Jon, "It's the Institutions, Stupid! Why Comprehensive National Health Insurance Always Fails in America", Journal of Health, Politics, Policy and Law, Vol. 20, No. 2, Summer 1995, pp. 329-372

CLASS 4 - AMERICAN VALUES

September 19

Class Objective: Student will understand the relationship of "American" values to health policy and politics.

Assigned Readings:

Draper, Elaine, "Genetic Secrets: Social Issues of Medical Screening in a Genetic Age", Hastings Center Report, Special Supplement, July-August, 1992, pp. 15-18.

Mechanic, David, "Health & illness in technological societies", Hastings Center Studies, pp. 7-18.

Morone, James A., "Enemies of the People", Journal of Health, Politics, Policy and Law, Vol. 22, No. 4, August, 1997, pp. 992-1020.

Veatch, Robert M., "The medical model: its nature & problems, Hastings Center Studies, pp. 60-76.

CLASS 5 - THE FEDERAL LEGISLATIVE BRANCH

September 26

Class Objective: Student will understand how the U.S. Congress functions in making national health policies.

Assigned Readings:

Hacker, Jacob S., Skocpol, Theda, "The New Politics in U.S. Health Policy", Journal of Health, Politics, Policy and Law, Vol. 22, No. 2, April, 1997, pp. 315-338.

Navarro, Vicente, "Why Congress Did Not Enact Health Care Reform", Journal of Health, Politics, Policy and Law, Vol. 20, No. 2, Summer 1995, pp. 455-462.

CLASS 6 - COMPARATIVE HEALTH CARE SYSTEMS

October 3

Class Objective: Student will understand the relevance of studying comparative health care systems with the objective of improving the U.S. health care system.

Assigned Readings:

LeGrand. "Competition, Cooperation, Or Control? Tales From The British National Health Service", Health Affairs, Vol.18, No. 3, May/June1999, pp. 27-39.

Jacobs, Alan, "Seeing Difference: Market Health Reform in Europe", Journal of Health, Politics, Policy and Law, Vol. 23, No. 1, February 1998, pp.1-33.

CLASS 7 - THE FEDERAL EXECUTIVE BRANCH: INTERFACING POLITICIAN AND BUREAUCRAT

October 10 (Mid-Term Examination Passed Out)

Class Objective: Student will understand the role of the Executive Branch in making national health policies.

Assigned Readings:

Fox, Daniel, "Health Policy and the Politics of Research in the United States", Journal of Health, Politics, Policy and Law, Vol. 15, No. 3, Fall 1990, pp.- 481-499.

Waitzkin, Howard and Hubbell, F. Allen, "Truth's Search for Power in Health Policy: Critical Applications to Community-Oriented Care and Small Area Analysis", Medical Care Review, Vol. 49, No. 2, Summer, 1992, pp. 161-189.

CLASS 8 - HEALTH CARE INSTITUTIONS - HOSPITALS

October 17

Class Objective: Student will understand the role of hospitals in developing national health policy.

Assigned Readings:

Thorpe, Kenneth E., "The Health Care System in Transition: Care, Cost, and Coverage", Journal of Health, Politics, Policy and Law, Vol. 22, No. 2, April, 1997, pp. 339-361.

CLASS 9 - STATE AND LOCAL GOVERNMENT

October 24

Class Objective: Student will understand the role of state and local government in health policy and politics.

Assigned Readings:

Paul-Shaheen, Pamela A., "The States and Health Care Reform: The Road Traveled and Lessons Learned from Seven That Took the Lead", Journal of Health, Politics, Policy and Law, Vol. 23, No. 2, August, 1998, pp. 319-361.

Jacobsen, Karen, McGuire, Thomas G., "Federal Block Grants and State Spending: The Alcohol, Drug Abuse, and Mental Health Block Grant and State Agency Behavior", Journal of Health, Politics, Policy and Law, Vol. 21, No. 4, Winter, 1996, pp. 753-770.

Bachman, Sara S. "Why Do States Privatize Mental Health Services? Six State Experiences", Journal of Health, Politics, Policy and Law, Vol. 21, No. 4, Winter, 1996, pp. 807-824.

CLASS 10 - HEALTH CARE INSTITUTIONS - INSURANCE, PROFESSIONAL ORGANIZATIONS

October 31 (Mid-Term Examination Due)

Class Objective: Student will understand the relationship of the health insurance and health professions organizations in influencing national health policies.

Assigned Readings:

Vladeck, Bruce. "The Political Economy of Medicare", Health Affairs, Vol.18, No. 1, January/February, 1999, pp. 22-36.

Liang, Bryan A. "Error in Medicine: Legal Impediments to U.S. Reform",

Journal of Health, Politics, Policy and Law, Vol. 24, No. 1, February, 1999, pp. 27-58.

Evans, Robert G., "Going for the Gold: The Redistributive Agenda behind Market-based Health Care Reform", Journal of Health, Politics, Policy and Law, Vol. 22, No. 2, April, 1997, pp. 427-465.

Ginsberg, Paul B., "The Dynamics of Market-Level Change", Journal of Health, Politics, Policy and Law, Vol. 22, No. 2, April, 1997, pp. 363-382.

Rice, Thomas , "Can Markets Give Us the Health System We Want ?", Journal of Health, Politics, Policy and Law, Vol. 22, No. 2, April, 1997, pp. 383-426.

CLASS 11 -CARING FOR THE UNINSURED AND UNDERINSURED

November 7 Class Objective: Student will understand the issues surrounding health services for the poor and working poor.

Assigned Readings:

Sparer, Michael S. "Devolution of Power: An Interim Report Card", Health Affairs, Vol.17, No. 3, May/June1998, pp. 7-16.

Marquis, M. Suzan, Long, Stephen H., "Federalism and Health System Reform: Prospects for State Action", JAMA, August 13, 1997 -Vol 278, No.6, pp. 514-517.

CLASS 12 - LOBBYING

November 14

Class Objective: Student will understand the techniques of lobbying

Assigned Readings:

Kronebusch, Karl, "Medicaid and the Politics of Groups: Recipients, Providers, and Policy Making", Journal of Health, Politics, Policy and Law, Vol. 22, No. 3, June, 1997, pp. 839-878.

Podhorzer, Michael, "Unhealthy Money: Health Reform and the 1994 Elections", International Journal of Health Services, Volume 25, Number 3, pp. 393-401, 1995.

November 21 Thanksgiving Recess - No Class

CLASS 13 MEDIA

November 28

Class Objective: Student will understand the major issues of the media and political advertising.

Assigned Readings:

West, Darell M., Heith, Diane, Goodwin, Chris, "Harry and Louise Go to Washington: Political Advertising and Health Care Reform", Journal of Health, Politics, Policy and Law, Vol. 21, No. 1, Spring, 1996, pp. 35-68.

CLASS 14 POLITICAL VALUES

December 5

Class Objective: Student will understand the functioning of the leadership in the House of Commons, U.K.

Film: "Yes, Minister - Party Games" Class discussion of universal human political values and culture specific values.

December 12- Major Research Paper or Annotated Bibliography Due.