POLI 216: Health Care Politics and Policy

Course Description

Since the presidencies of FDR and Harry Truman, health care has been one of the most important public policy issues in American politics. Over the past eighty years, a sizable percentage of Americans have traditionally held deep concerns about both the limited access to and the high cost of health care. Yet while many Americans believe that the health care system needs major changes, there is little consensus as to what the appropriate solutions are. Complicating the matter even further, many people find the issues in health care policy to be extraordinarily complex.

In this class, we will examine each of the major U.S. federal health care programs (Medicare, Medicaid, and SCHIP) to determine why each program was created, how each evolved, and what impacts each has had on the American health care system. Second, we will examine the cost-effectiveness of the system. Do Americans get their money’s worth out of their health care system? Third, we will examine recent reforms that have been proposed and/or enacted at both the state and federal level including the Affordable Care Act (e.g. Obamacare). What have been the effects of these reforms? Finally, we will examine how other countries have constructed their health care systems. Should Americans look elsewhere for solutions to their health care system?

Because the history of American attempts to reform the health care system has been necessarily intertwined with changes in the broader political landscape of American politics, we will spend some time at the beginning of each class reviewing major developments both in health care policy specifically and American politics generally.

News, Media, and Policy Sources

The Kaiser Family Foundation is an excellent provider of health policy news. Students are required to subscribe to the free Morning Briefing as well as the California Healthline Daily Email. To subscribe, go to:

https://kffhealthnews.org/email/

About a third of the way down the page, you will see a box that offers you to “Sign Up To Get The Morning Briefing In Your Inbox”. Please do so.

Please also sign up for one or more of the free emails published by the Journal of the American Medical Association (JAMA). To subscribe, go to:

https://jamanetwork.com/journals/jamanetworkopen

On the bottom right hand corner, you will see the option to “Get the latest from JAMA Network Open”. Enter your email address and hit the “Sign Up” button.

You might also conduct frequent searches of Google News using the search term “Health Care”. Other outstanding media sources that you might consult throughout the term include The Wall Street Journal (https://www.wsj.com), the Associated Press (https://apnews.com), Reuters (https://www.reuters.com), The New York Times (https://www.nytimes.com), the PBS Newshour (http://www.pbs.org/newshour/) and the Sacramento Bee (http://www.sacbee.com/). You might also consider following each of them on X (formerly Twitter) and/or Facebook as well.

All University of Redlands students should take advantage of the free digital New York Times subscriptions offered by the university. To activate your pass for free access, go to https://nytimesineducation.com/access-nyt/ and follow the instructions. Following your registration, go to nytimes.com/mobile to download the free apps. Please read a major, nationally recognized news source on a daily basis, and be prepared to talk about the key political developments each day in class.

Professor Thorson’s Favorite Facebook “Likes”

Professor Thorson’s Favorite X (Twitter) Feeds to Follow

Course Outcomes

Students who complete the class should demonstrate:

• how different methods and types of evidence are used in the study of health care politics and policy, and how we construct knowledge of health care politics and policy through the analysis of empirical evidence,
• how to identify and define the operation of power, privilege, and inequality, as well as articulate and/or critique the ways these forces have operated, been resisted, and/or transformed in the context of health care politics and policy,
• how to solve contextual problems involving quantitative relationships within health care politics and policy by means of numerical, visual, or symbolic representations in the context of specific discipline(s) by constructing, refining, or applying quantitative models to draw well-reasoned conclusions while nevertheless identifying potential limitations to models and analyses, such as restrictive assumptions, uncertainties in data, and errors in reasoning,
• a thorough knowledge of how the major U.S. federal health care programs (Medicare, Medicaid, and SCHIP) work;
• how cost effective the U.S. health care system is in comparison to other health care systems in the world;
• an understanding of recent attempts (both federal and state) to reform the U.S. health care system;
• an ability to follow and analyze the most recent policy development in health care;
• substantive expertise in an area of health care politics and policy of the student’s choice as demonstrated by the writing of a public policy brief that analyzes health care politics and policy.

Course Delivery Model

Students are responsible for their own learning and growth in the class. To assist students, I have selected outstanding articles from the field. It is the responsibility of the student to come to class each day fully prepared to discuss the content of the articles as well as to share critiques and/or opinions about each article. I see my primary role as a facilitator. While I will have some questions prepared for each class session, discussion will primarily be led by students.

Required Texts

The required course textbooks are:

• Brasfield, James M. 2011. Health Policy: The Decade Ahead. London: Lynne Rienner Publishers.
• Paul, Richard and Linda Elder. 2019. The Miniature Guide to Critical Thinking: Concepts and Tools (Eighth Edition). Tomales, CA: Foundation for Critical Thinking.

Each of these texts can be found in the campus bookstore, online, and with many other book sellers. Additional readings can be found on the course Moodle site. I strongly encourage you to print these articles out and write extensive notes on them.

Grades

Final grades for the course will be based on your performance in the following areas:

• Daily Participation/Quizzes — 35%
• Midterm Exam — 25%
• Final Exam — 25%
• Policy Brief — 15%

Course grades will be assigned using the following guidelines:

Exams

Both exams will be closed book and closed note. Each exam will be composed of predominantly essay questions. I will provide you with a review sheet for each exam to assist you in your preparation. The midterm exam will last 75 minutes. The final exam will last two hours.

Daily Quizzes / Participation

Students will be graded on their timely presence in class as well as their participation in class discussion. Students are required to have read the assigned material before coming to class. Your participation grade will be based on your physical presence in class, the quantity and quality of your contributions to the class discussion, and the extent and quality of your preparation for class as measured by your participation in class and daily class quizzes.

Class attendance, as well as taking the quizzes, is required for completion of the course. We will take daily quizzes using Poll Everywhere. Please download the free Poll Everywhere software for your phone or tablet. While you can take the quiz on your computer from the Poll Everywhere website ( www.PollEv.com/profthorson ), students have experienced fewer glitches by using the various apps from their mobile devices. Please login to the app using your @redlands.edu email address and choose PollEv.com/profthorson to join the presentation.

You will take daily quizzes that ask you about (a) the main points from the previous class discussion, and (b) the major points addressed in the new readings to be discussed in class that day. These quizzes will reward you for both attending class, paying attention during class, and for being prepared for class each day.

Policy Brief

Writing in the field of political science and public policy is quite different than in many other fields. Policymakers generally prefer short, concise statements that rely heavily on evidence and previous research. Unfortunately, they rarely have time to read research papers, many of which are 20+ pages in length. As a result, your ability to summarize the research on a specific policy question is an invaluable skill.

For the purposes of this assignment, consider yourself a research aide to a local, state, or federal policymaker or committee. You are writing a policy brief to summarize for your boss the research written about a specific policy question in which s/he will face questions from some combination of the public, donors, lobbyists, or other public officials. Your goal is to provide your boss with a non-partisan, non-ideological summary of the research about this specific question.

When appropriate, identify areas of consensus in the research, areas of credible disagreement, and highlight what is known with confidence and what remains uncertain. You might also find it appropriate to evaluate the strength of the evidence in each piece that you are summarizing.

Suggested Structure

Some students have found the following structure helpful:

• Title – Frame in the form of an interesting and relevant policy question
• Executive Summary – Summarize in one paragraph the question, its importance, and your core findings/conclusions
• Background, Policy Context, and Importance – Provide a limited history of the problem, its relevance, and evidence of its importance
• Research Summaries – Offer powerful summaries of a few major pieces of research. Reprint key tables, figures, and/or data summaries.
• Areas of Agreement and Disagreement – How much consensus was there among the various authors?
• Policy Implications – Why are the contents of this brief important?
• Further Reading – For interested readers, what other works do you recommend?

Your policy brief may be no longer than three pages in length, single-spaced, and contain ample graphics and data. A fourth page must be added that only includes a Works Cited/Further Reading section and any appropriate appendices.

The graphical layout of policy briefs is important. Policymakers need to scan policy briefs quickly to find the content that they find important. You are encouraged to use side bars, graphics, and tables. Graphics should be directly tied to the research and must be appropriately numbered, clearly labeled, and offer appropriate citations. All graphics must be interpreted separately in the text of the brief.

You may choose to write about the policy question of your choice, but you are expected to extensively research the question. You may use materials that we covered in class.

Choose a specific research question that is of appropriate size and scope of a short policy brief. Make sure there is ample research for you to draw upon. Eliminate all personal opinion from your brief. Rather, bring the research of others together in your brief in a concise, useful manner.

Previously Approved Topics

Previously approved paper/brief topics include:

• Compare the U.S. to one or more health care system outside the U.S., such as Canada, Japan, Germany, etc. and compare them to each other or to the U.S. to determine if a particular structure, policy, or process is more or less effective;
• Describe the specific impacts of a major government program or a modification being made to it;
• Examine the impacts of some state and/or city health care reform, such as Vermont, Massachusetts, Maryland, or San Francisco;

Make the tone of your policy brief objective and guided by evidence rather than ideology or partisanship. Write like a scientist. Avoid at all costs the normative aspects of a policy question and simply report on the research. Focus on the findings of your research rather than your own personal views.

Additional Resources on Policy Briefs

As you begin writing your policy brief, I encourage you to consult the following readings:

• The Writing Center at University of North Carolina at Chapel Hill. “Policy Brief”. http://writingcenter.unc.edu/policy-briefs/
• The World Bank. “Developing Policy Briefs: Informing Policies with Ecosystem and Landscape Assessment Results.” World Bank Policy Brief Guide
• University of California at Davis Graduate Program of Environmental Policy and Management. “Guide for Writing Policy Briefs”. UC Davis Policy Brief Guide
• Web video: “The Art and Craft of Policy Briefs: Translating Science and Engaging Stakeholders”: https://www.youtube.com/watch?time_continue=109&v=R1GpcAoBvnc

Each of these readings contains valuable, practical advice on writing policy briefs. The video provides some examples of briefs as well. See additional resources and exercises on the course site.

To assist you with your research, you might consider meeting with a reference librarian in the Armacost Library, searching major electronic databases, including EBSCO, ERIC, JSTOR, Lexis-Nexis, and/or Google Scholar, as well as public policy think tanks (e.g. Brookings, AEI, Rand, etc.). When using Google Scholar and JSTOR, consider finding a classic article on the topic and clicking the “Cited by” link.

Pay close attention to the quality of your sources. The strongest sources will be from reputable think tanks and research organizations, top journals in public policy, economics, and perhaps political science (e.g. Journal of Policy Analysis and Management, journals of the American Economic Association, etc.) as well as books written from the top university and perhaps law school presses (Oxford, Cambridge, Johns Hopkins, Michigan, Harvard, Yale, etc.).

Your bibliography and citations should follow the American Political Science Association (APSA) style manual. It can be found at: APSA Style Manual .

Evaluation Criteria

Your briefs will be evaluated based on:

• The clarity and importance of the policy question
• The quality and credibility of the sources
• The accuracy and skilled synthesis of the articles
• The effective use of data and visualizations
• The organization and readability of the brief
• Adherence to a non-normative, evidence-based tone

Writing Deadlines

A one-page policy brief prospectus that outlines the specific policy question featured in your policy brief as well as at least three academic sources must be uploaded to Canvas no later than Friday, March 20th at 11:59pm. Your prospectus should introduce your specific research policy question as well as discuss its importance. Your prospectus should also list at least three academic sources that you will review and cite in your brief. Sources covered in class do not count towards the source minimums. Your prospectus should be single-spaced.

Your final policy brief is due at the beginning of class on Tuesday, April 14th.

Late briefs will be penalized a full letter grade per calendar day.

Students are also encouraged to take advantage of the writing assistance offered by Student Services.

Office Hours

Please feel free to stay a little longer after class to ask any non-confidential matters related to the class content and/or if you have academic questions. I enjoy getting to know you!

For other matters, please set up an appointment using the following link: Office 365 Bookings for Professor Thorson .

Please arrive to your appointment no later than five minutes before your scheduled start time. If you need to cancel a meeting, please do so at least 24 hours in advance.

Please note that “no shows” to appointments waste a lot of time, are annoying to the professor, and limit the availability of appointments for other students. Please make sure to keep your appointments!

Technology in the Classroom Policy

While I don’t formally ban the use of laptops, tablets, and cell phones in class, I strongly encourage you to turn these devices off during class and use paper and pen/pencil for note-taking. There is strong evidence that this method of note-taking is far superior to that of note-taking on a screen.

Office of Equity and Title IX

In order to provide a safe and equitable learning environment for all students, faculty, and staff, discrimination, harassment, retaliation, sexual misconduct, and sexual harassment (including sexual assault, dating or domestic violence, and stalking) are not tolerated at the University of Redlands. The University prohibits unlawful discrimination or harassment (as defined in the Policy Prohibiting Discrimination, Harassment, Sexual Misconduct, and Retaliation) on the basis of age, color, race, ethnicity, national origin, ancestry, sex, marital status, pregnancy, status as a complaining party of domestic violence, sexual orientation, gender, gender identity or expression, physical or mental disability, genetic information, religion/creed, citizenship status (except to comply with legal requirements for employment), military/veteran status, or any other characteristic protected by law. If you or someone you know has experienced or experiences any of these behaviors, know that you are not alone. You can contact the Office of Equity and Title IX for reporting options, supportive measures, and resources to support you.

Many faculty and staff at the University of Redlands are considered “Responsible Employees,” which means that if you tell me about a situation involving any of the above, I must report the matter to the Office of Equity and Title IX. Although I make that report, you are in control of how you would like to proceed, including whether or not you wish to pursue a formal complaint. Our goal is to make sure you are aware of the range of reporting options available to you and have access to the support and resources you need.

To report an incident directly, you can:

• Contact the Interim Director of Equity & Title IX, Christopher Jones, at 909-748-8289 or titleix@redlands.edu
• Report online at: https://www.redlands.edu/offices-directory/offices/office-of-equity-and-title-ix

You can also report to local law enforcement at 909-798-7681, ext. 1. If you are ever in immediate danger, please call 911 or email/text 911@redlandspolice.org if you cannot call. To reach Public Safety on campus, call 909-748-8888 or use the Rave Guardian app.

If you wish to speak to someone confidentially (meaning not connecting with the Office of Equity and Title IX Office), you can contact:

• Counseling Center: 909-748-8108 or 24-Hour Crisis Line: 909-748-8960
• TimelyCare, 24/7 emotional support; 12 free telehealth counseling sessions
• Partners Against Violence, 24-hour sexual assault crisis line: 909-885-8884
• Option House, 24-hour dating/domestic violence crisis line: 909-381-3471
• https://www.rainn.org/ (sexual assault)
• https://www.loveisrespect.org/

For more information, visit: www.redlands.edu/titleixandequity .

Writing Tutoring

Peer writing tutoring is available in-person and online throughout the semester. You can visit a tutor at multiple stages of your writing process for each project/assignment/essay/etc. You and your tutor can have a brainstorming conversation if you aren’t sure where to begin, and you can continue to meet throughout your drafting and revision process. Please note that tutors can assist with writing in ALL disciplines, not just the humanities.

You can schedule a tutoring session at https://redlands.mywconline.com .

You can contact the office of Academic Support and Accessibility at asa@redlands.edu or call 909-748-8069 if you have any questions. They’re happy to help any time!

Subject Tutoring

Peer subject tutoring is available in-person and online throughout the semester for many courses. You can select your specific course when you log in to the Subject Tutoring Fall 2024 schedule at https://redlands.mywconline.com . Select the tutor and time of your choice. All tutors are students who have taken the same course, often with the same instructor.

You will need to book your tutoring session at least one day in advance and provide details about what you would like to work on to allow your tutor enough notice and preparation time.

You can meet with your tutor as little or as often as you’d like, up to two hours per week per course. Students at the UoR use tutoring to work on all academic goals, from better understanding difficult concepts to achieving a 4.0. Tutoring is individualized to each student.

You can contact the office of Academic Support and Accessibility at asa@redlands.edu or call 909-748-8069 if you have any questions. They’re happy to help any time!

Counseling Center & CARE Team

Counseling Center

The Counseling Center provides free and confidential mental health services, including short-term individual therapy, group therapy, single-session therapy, consultations, and urgent appointments to all students with in-person or virtual options. The Counseling Center is committed to inclusivity and to providing a supportive space for everyone.

Please call 909-748-8108 to schedule an appointment or email counseling_center@redlands.edu. If a student is in crisis, please call 909-748-8960 for the 24/7 mental health crisis line. For more information on resources, see the Counseling Center website. Another option for individual therapy for all students is TimelyCare, which provides virtual therapy immediately (Talk Now) or up to 12 scheduled virtual therapy sessions per year.

CARE Team

The University CARE Team exists to help provide support and resources to students that are overwhelmed, experiencing significant distress, or possibly present some risk to themselves or others. As a faculty member, I may reach out to students about whom I am concerned to talk individually, and/or refer them to the CARE Team.

If you have concerns about a fellow student, consider sharing your concern with the CARE Team via their online form. This is part of who we are as a caring, proactive community where we all look out for one another.

Additionally, if you feel that you or someone else needs immediate mental health support, the University has a 24/7 mental health crisis line at 909-748-8960, and the TimelyCare app, which offers on-demand emotional care. Both services connect to a live, licensed counselor.

Financial & Academic Support Resources

Emergency Student Loans

Student Financial Services (SFS) administers a short-term, no-interest loan fund to assist students experiencing an emergency or cash-flow problem. Except in unusual circumstances, these loans do not exceed $200 and are billed to the student’s account. Evidence of repayment ability is a prerequisite for all short-term loans made to students. Students are eligible for one emergency student loan per term.

Contact: SFS@redlands.edu or x8047.

Student Food Support Pantry

The Student Food Support Pantry is a resource available to all established full and part-time University of Redlands students facing food insecurities. The Pantry is located on the north side of North Hall (look for the banner with Bulldog on it). Hours of operation are Monday through Friday from 11:30 a.m. to 6:00 p.m. year-round.

This space is an open, no-questions-asked space with dried and canned goods, and non-perishable items, as well as seasonal fresh produce from our sustainable farm and limited refrigerated goods. Food for this distribution is provided in partnership with Feeding America Riverside and San Bernardino. It is also funded through private donations and the Office of Community Service Learning.

For more information, please contact SURF@redlands.edu.

Conflict Resolution Center

Experiencing a conflict? Whether it’s with a friend, roommate, another member of a student organization, or faculty or staff member, conflicts happen. Learning to navigate conflicts is important to success in virtually any field, and a vital step in being a part of a community and having healthy, meaningful relationships with others. Please contact crc@redlands.edu for more information.

Book Lending Program

The Book Lending Program is an initiative to ensure the academic success of First-Generation students (students who are the first to go to college in their families and who meet a particular estimated family contribution [EFC] level). Funded through alumni donations, this program provides books and other classroom materials, when needed, for First-Generation students who could not otherwise afford to purchase them.

Books are returned at the end of the course, to be used by other First-Generation students the next semester. The program works alongside the Library and faculty members to ensure the availability of books and classroom materials.

For more information, see: Book Lending Program . Contact: blp@redlands.edu.

Technology Lending

The Armacost Library provides loans of laptops and other technology, including Bluetooth headphones, digital audio recorders, and smart pens, which can assist with note-taking and audio recording. For those needing ergonomic or accessibility devices, the library has ergonomic keyboards, high visibility keyboards, an ergonomic joystick, and an ergonomic trackball. These resources are accessible to all University of Redlands students on a first-come, first-served basis.

For a full list and to check the availability of these items, please visit the Armacost Library webpage or call (909) 748-8022.

Student Discretionary Fund

The Student Discretionary Fund, managed by Student Affairs, is designed to support student success by addressing financial challenges that could otherwise lead a student to pause or discontinue their education. The support provided can cover a range of personal expenses, including utility bills, gas money, emergency travel home due to a family tragedy, off-campus counseling, medical costs, and occasionally mental health assessments.

Grants from this fund are awarded based on the student's financial need. To apply, students can complete the Student Discretionary Fund Application, which is available at https://forms.office.com/r/aX7dvAnbG2 or contact student_affairs@redlands.edu.

Student Lounges

Lounges for all students to sit, work, and eat can be found on the University website under student resources and campus facilities.

Freedom of Expression

I am committed to the free expression of ideas in my classroom. Particular viewpoints should not be privileged simply because they are popular or supported by influential elites. All ideas and their corresponding assumptions must be defended by reason and evidence. It is my belief that free inquiry is a human right, should be a core value at all universities, and will be protected in my classroom even if doing so will come at great cost.

What does this mean for you? If you enroll in one of my classes, you may hear statements that you consider disagreeable, inappropriate, or offensive. All members of the class will be given very broad discretion to speak and write what they want. My classroom is not a “safe space”, nor is it designed to be a comfortable place. Indeed, free expression should cause you discomfort. It should cause you to reexamine your assumptions, values, and beliefs.

Does this mean that you can say anything in my class? No. Among other restrictions on speech, you may not threaten or harass others in the class. You may also not use your freedom of expression to suppress the expression of the views of others in the class.

Students who make offensive statements should also expect to be challenged by others who also enjoy their own freedom of expression.

It is my hope that our class can be as challenging and intellectually rigorous as possible.

Academic Honesty

Quizzes and exams are not collaborative. You are not allowed to talk with any of your peers or look at anyone else’s quiz or exam during the testing period.

Policy briefs are to be written solely by you. Proper citation (including citing AI) must be used whenever you are utilizing someone else’s ideas.

Scholastic dishonesty means plagiarizing; cheating on assignments or examinations; engaging in unauthorized collaboration on academic work; taking, acquiring, or using test materials without faculty permission; submitting false or incomplete records of academic achievement; acting alone or in cooperation with another to falsify records or to obtain dishonestly grades, honors, awards, or professional endorsement; altering, forging, or misusing a University academic record; or fabricating or falsifying data, research procedures, or data analysis. In this course, a student responsible for scholastic dishonesty can be assigned a penalty up to and including an "F" or "N" for the course.

You are responsible for both understanding and obeying both these and other University policies on academic honesty. Academic dishonesty in any portion of the academic work for a course shall be grounds for awarding a grade of F or N for the entire course.

Names and Personal Gender Pronouns

It is important to me that I learn both your preferred name and personal gender pronoun. If I state either incorrectly, please correct me either during or after class.

Withdrawal / Incomplete

Students are responsible for voluntarily withdrawing from the class should they decide not to complete it. If your name appears on the registrar’s final grade sheet and I can find no work on which to base a grade, I must give you an “F”. I observe all University drop deadlines.

Course Outline / Assignments

Please note this is a tentative schedule and may be adjusted at any time by the Professor.

Final Examination

The final exam will be held in person (in our scheduled classroom) on Saturday, April 18th from Noon to 2pm or at the official time designated by the Registrar’s Office.

Do not plan to depart Redlands until your finals are completed!