Course Description
Roughly one-sixth of the gross national product of the United States is spent on health care, and at least one-sixth of American domestic politics concerns health issues. Health politics and policy is such a big realm that entire schools with dozens of faculty within large universities are devoted to it. So this course does not attempt to comprehensively cover all aspects of health policy and politics.
Instead we focus on one essential question: Why is the American health care systemso different from that of other affluent nations? Or to put it more sharply,why is the United States the only affluent nation that does not ensure that nearlyall its citizens receive basic health care? To answer those questions, we mustlook back in time and across borders—back in time to the origins of theAmerican health care system and across borders to other affluent nations to comparetheir health systems.
Along the way we will learn about the development of the health professions,the rise of health insurance, and transformations in health care delivery—butalso about American political history, political culture, and the distinctiveshape of American government. Indeed, much of this course is concerned with questionsthat could be applied to any policy realm: Why do some social problems becomematters of great public attention, while others are ignored? What makes somegroups in society more politically powerful than others? Are political outcomesmore determined by public opinion, the choices of political leaders, the powerof interest groups, or the shape of a nation’s political institutions?Because it is so complex and dynamic, health policy turns out to be a wonderfularena for studying core issues in politics.
Politics is in part about argument, so to understand the politics of health carewe will from time to time debate the merits of various proposals to reform theAmerican health care system. But you should know that this is not designed asa course in “policy analysis.” If you want to study what kind ofhealth care system is best, or analyze the merits of competing policies, I urgeyou to take the health economics course offered in the EconomicsDepartment. That will give you some basic tools with which to measure tradeoffsamong different policies.
If your goal is to figure out the best possible system for health care in anideal world, this course will prove disappointing. But if you want to understandwhat kinds of policies are likely to be politically feasible, and underwhat conditions such policies are likely to be enacted into law—in otherwords if you want to understand politics of health policy--then this course isfor you.
GOALS AND REQUIREMENTS
The main goal of this course is for you to understand the American health care system and the political factors that have created and sustained it. But along the way this course also will help you develop your abilities in some areas that will likely help you even if your post-Wellesley life has little to do with health care.
First, you will learn basic theories of the politics of public policy that can be applied beyond the United States and beyond the realm of health care.
Second, you will learn to apply these theories to real-world politics. You will do this both in your papers and in a series of class presentations.
Third, and perhaps most important, these class presentations will give you a chance to a develop an important set of skills. When Wellesley alums are asked what skill they wish they had developed better in college, the number one answer is oral presentation. Employers rarely ask for term papers, but they frequently require employees to make presentations. More broadly, learning to present yourself and your ideas in person will serve you in just about anything you plan to do post-Wellesley.
You will make some presentations by yourself; for others you will work with a team. Most work (and most of your life outside of work!) involves teamwork, and research on college life suggests that teamwork is a useful way in which students can develop connections and learn from each other. Students often balk at teamwork either because they are not by habit team players or because they don’t want their grades weighed down by the sins of teammates. To such students (of which I was one, by the way) I offer this solace: the team presentations are only a tiny percentage (10%) of your grade, so your fate in the course will in most cases have little to do with what your team does. That said, the work you will do with your fellow students will serve as a lauching pad for your research papers so in that sense you will want learn how to work effectively with them.
You will have plenty of help along the way to develop your skills in presentation giving. Tutors and materials from the Learning and Teaching Center will be available, and I will provide a detailed, constructive critique of each presentation you make.
The most basic requirement of this course is that you show up each week readyto participate in class discussions. The class will ordinarily be runas a discussion, with in-class debates, presentations and simulations. I maylecture on a few days but this will be the exception, so that the quality ofclass sessions will depend on your preparation.
Participation (30%) The participation grade is based on your performance on a series of mini-assignments, and on the quality of your participation in class discussions. In order to be ready to participate, you must go beyond simply reading the day's assigned material, you must be ready to respond to questions I will pose to you. Those questions will be included in a study guide for the day’s reading. On many days I will ask you to post a response to a question I have posed; those posts will be the basis of our class discussion. If you are a shy student I urge you to use this course to work on your skills in oral presentation. I often find that when shyer students get the courage to speak up, they often have better, more thought-out ideas than students who speak all the time. Don’t feel that you have to be eloquent; it’s okay to stumble or say dumb things from time to time (I often do, as you’ll learn). I just want to know that you are keeping up on the reading and thinking about it creatively and critically. You needn’t participate every class, but try to help out, especially when the class is stuck on a question, and if you don’t speak often, try to put real energy into the mini-assignments.
Group Presentations (10%) At two points in the class you will be asked to work with partners to research and present on topics in health care policy. Your group will be graded both on the depth of your research and the quality of your presentations. Researching these presentations will also help prepare you for the research papers.
Short Research Papers (50%) You will write two 7-10 page papers thatwill 1)compare health policy in the United States to that of another affluent nation;and 2) consider the political prospects for a health care policythat you would like to see enacted into law.
Current Events Presentation (10%) Twice during the semester you will be asked to report to the class on a newspaper, magazine or internet article relating to some aspect of health care policy. The article should be posted to the course FirstClass conference in advance of the class. In class you will describe the article and why you find it interesting. Your presentation will be graded on the extent to which it stimulates class discussion, relates to course material, and raises significant issues.
MATERIALS
Four books are required in the course:
Laurie Kaye Abraham, Mama Might Be Better Off Dead
Paul Starr, The Social Transformation of American Medicine
John Kingdon, Agendas, Alternatives and Public Policies
Theda Skocpol, Boomerang!
In addition, several articles will be on e-reserve or sent via email.
DROP-IN HOURS AND ELECTRONIC COMMUNICATION
My drop-in hours are Wednesdays 2:00-4:00, Fridays 1:30-2:30 and by appointment. Normally they will be held at my office at 234 Pendleton. The drop-in hours are your chance to discuss anything you wish, from coursework to internships and career plans. No appointment is necessary. If when you arrive I am speaking to another student, please knock on my door to show me that you’re around so that I know that you’re waiting.
I am generally available via email and will often respond to notes quickly, but be warned that I occasionally sever the electronic umbilical cord, especially over weekends, so that a quick turnaround is not guaranteed.
If for any reason you feel you have serious concerns about meeting the course requirements as specified, please talk with me the first week of class to discuss your particular situation.
GRADING POLICIES
I am happy to read drafts of your work, but please submit your draft at leastthree days in advance of the due date; otherwise I cannot guarantee that I willhave time to read them.
I adhere to Wellesley's official grading policy, which is thatA's are reserved for "students who meet with conspicuous excellenceevery demand that can fairly be made by the course." (My emphasis added.)In practice this means that to receive an A or A- you must not merely meet allthe standards on an assignment but exceed those standards. If you all requiredelements of an assignment will entitle you to a B+. Needless to say this is notnecessarily the policy of all professors at Wellesley, so if you are worriedmost about preserving a high grade point average you may want to consider othercourses.
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