https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeUjhvZzBNMnhMSzA/edit
PubH 8801
Health Services Policy Analysis: Theory
Fall 2013
Credits:
3
Meeting Days:
Tuesday, September 3 – December 10, 2013
Meeting Time:
11:15 am – 2:15 pm
Meeting Place:
2-120 Moos Tower
Instructors:
Roger Feldman
Ira Moscovice
Office Address:
15-215 Phillips Wangensteen Building
15-205 Phillips Wangensteen Building
Office Phone:
612-624-5669
612-624-4818
Fax:
612-624-2196
612-624-2196
E-mail:
feldm002@umn.edu
mosco001@umn.edu
Office Hours:
By appointment
By appointment
I.
Course Description
The course is designed to introduce students to the discipline of public policy analysis. Public policy analysis
is the application of perspectives from analytic disciplines such as economics, political science, sociology
and law to problems that arise in the public sector. This course will focus on economic and political
perspectives and will include perspectives on cultural influences and the policy-making process, as well.
II.
Course Prerequisites
Graduate or professional school student or instructors’ consent.
III. Course Goals and Objectives
Upon completion of the course, the student should be able to take descriptions of problems and analyze the
nature and characteristics of the problem, the likelihood that it constitutes a public policy problem, and
approaches to the problem one would expect to observe in the private sector, or that one might recommend
to the public sector. In addition, the student should have familiarity with the policy-making process and
understand the role of political perspectives in the formation and implementation of policy proposals
IV. Methods of Instruction and Work Expectations
The philosophy of the course will be to present concepts and ideas by maximizing class participation.
Students are expected to read all required readings before class and be prepared to discuss the main
theories, concepts, and issues described by the authors. Grades will be based on: three take-home exams
due Weeks 6, 11, and 15 (each 30% of grade) and class participation in the seminar discussions (10% of
1
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grade). Late assignments will be marked down one letter grade. Collaborating on graded papers is strictly
forbidden and can result in dismissal from the program. Students should review the department and
university statements on plagiarism. Plagiarism will result in failure of the course and possibly dismissal from
the program.
V.
Course Text and Readings
Rosen, Harvey and Ted Gayer. Public Finance. 9th Edition. McGraw-Hill. (2009).
Kingdon, J. Agendas, Alternatives and Public Policies, Updated 2nd Edition. Boston: Longman. (2010)
In addition, students are expected to check the following websites on a regular basis:
1. Kaiser – Kaiser Daily Health Policy Report
2. American Enterprise Institute – AEI Today
3. New York Times
4. Washington Post
5. Families USA – Health Care Reform Central @ http://www.familiesusa.org/health-reform-central/
6. The Morning Consult, postmaster@themorningconsult.2dialog.com
7. National Conference of State Legislatures
8. National Governors Association
VI. Course Outline/Weekly Schedule
Class Meeting
Week 1 – 9/3
Topic
The Welfare Economics Approach to Policy (Roger)
Readings
1. Rosen and Gayer, Chapters 1 & 3
2. Abram Bergson, “A Reformulation of Certain Aspects of Welfare
Economics,” Quarterly Journal of Economics, 52:2 (February, 1938), 310334. http://www.jstor.org/stable/pdfplus/1881737.pdf?acceptTC=true
3. Francis M. Bator, “The Simple Analytics of Welfare Maximization,”
American Economic Review, 47:1 (March, 1957), 22-59.
http://www.jstor.org/stable/pdfplus/1881737.pdf?acceptTC=true
Optional
4. John F. O’Connell, Welfare Economic Theory, Boston, MA: Auburn House
Publishing Company, 1982.
5. E.J. Mishan, “A Survey of Welfare Economics, 1939-59,” The Economic
Journal, 70:278 (June, 1960), 197-265.
Week 2 – 9/10
The Evolution of Health Policy in the U.S. and a Framework for Policy
Analysis (Ira)
The evolution of health policy in the U.S. since the 1940s; an examination of current
policy issues and why they become prominent issues; a framework for policy
analysis.
Readings
1. Longest, B. Health Policymaking in the United States, Fifth Edition.
Chicago, IL: Health Administration Press, 2010. (Appendix 3)
The elaboration of a policy analysis framework.
 What are the main components of a policy analysis framework and why are
they important?
 How does this framework help us understand the evolution of health policy
in the U.S.?
Readings
1. Aitkins, D., J. Siegel, and J. Slutsky. “Making Policy When the Evidence is
in Dispute.” Health Affairs 24:102-113, 2005.
2
https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeUjhvZzBNMnhMSzA/edit
http://content.healthaffairs.org/content/24/1/102.full.pdf+html
2. Bryson, J. “What To Do When Stakeholders Matter.” Public Management
Review 6:21-54, 2004.
http://web.ebscohost.com/ehost/results?sid=a68bea32-ebe8-4b9e-a8b7df01c264b0a7%40sessionmgr15&vid=2&hid=8&bquery=JN+%22Public+M
anagement+Review%22+AND+DT+20040301&bdata=JmRiPWJ1aCZ0eXB
lPTEmc2l0ZT1laG9zdC1saXZl
3. Gold, M. “Pathways to the Use of HSR in Policy.” Health Services Research
44:1111-1135, 2009. http://onlinelibrary.wiley.com/doi/10.1111/j.14756773.2009.00958.x/pdf
4. Longest, B. Health Policymaking in the United States. Fifth Edition.
Chicago, IL: Health Administration Press, 2010. (Chapter 1).
5. Welch, H.G. “Testing What We Think We Know.” New York Times, August
19, 2012. http://www.nytimes.com/2012/08/20/opinion/testing-standardmedical-practices.html?_r=0
Week 3 – 9/17
Welfare Economics Reconsidered (Roger)
Readings
1. Amartya K. Sen, Collective Choice and Social Welfare, San Francisco:
Holden-Day, Inc., 1970, Ch. 1, 3, 3*, and 6. Ch. 3 and 3* are required, but
in order to read them you will need to review Ch. 1. Also read Ch. 6, a
critique of some restrictions that have been placed on social welfare
functions.
2. Nicholas Kaldor, “Welfare Propositions of Economics and Interpersonal
Comparisons of Utility,” The Economic Journal, 49:195 (September, 1939),
549-552. http://www.jstor.org/stable/pdfplus/2224835.pdf
3. Thomas Rice, “An Alternate Framework for Evaluating Welfare Losses in
the Health Care Market,” Journal of Health Economics, 11:1 (May, 1992),
85-92. http://www.sciencedirect.com/science/journal/01676296/11/1
4. Roger Feldman and Bryan Dowd, “What Does the Demand Curve for
Medical Care Measure?” Journal of Health Economics, 12:2 (July, 1993),
193-200. http://www.sciencedirect.com/science/journal/01676296/12/2
Optional
5. Manuel Trajtenberg, “The Welfare Analysis of Product Innovations, with an
Application to Computed Tomography Scanners,” Journal of Political
Economy, 97:2 (April, 1989), 444-479.
6. Roger Feldman, “The Welfare Economics of a Health Plan Merger,” Journal
of Regulatory Economics, 6 (1994), 67-86.
Week 4 – 9/24
How Government Functions in a Democratic Society (Ira and Roger)
The organization of the Federal government, how it functions, the relationships
between the administrative, executive, and judicial branches, and the role of
government in a democratic society.
 This session focuses on the constitutional basis for the U.S. government
and how the branches interact to shape policy.
 How does each branch influence the nature of policy and what shifts have
taken place in power over the past decade?
 Is there a positive theory of government?
Readings
1. James M. Buchanan and Gordon Tullock, The Calculus of Consent: Logical
Foundations of Constitutional Democracy, Ann Arbor, MI: University of
Michigan Press, 4th ed., 1971. Chapter 6 is critical but other chapters are
helpful background.
2. Anthony Downs, An Economic Theory of Democracy, New York: Harper &
Row, 1957. Read Ch. 1 and 2: “Introduction” and “Party Motivation and the
Function of Government in Society.”
3. Holahan, J., Weil, A., and Wiener, J. (eds.) State and Federal Roles in
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Health Care, Chapter 2 in Federalism and Health Policy, Urban Institute
Press, Washington, DC, 2003.
4. Weil, A. “Promoting Cooperative Federalism Through State Shared
Savings.” Health Affairs, 32:8 (2013), 1493-1500.
http://content.healthaffairs.org/content/32/8/1493.full.pdf+html
Optional
1. William H. Riker, The Theory of Political Coalitions, New Haven, CT: Yale
University Press, 1962. We may not cover this reading, but with Buchanan
and Tullock and Downs, it comprises the foundation of public choice theory.
2. (Mancur Olson, Jr., The Logic of Collective Action: Public Goods and the
Theory of Groups, New York, Schoken Books, 1971.
Activity: Why do people vote when voting has significant costs and almost no
payoff?
Week 5 – 10/1
What’s Wrong with the U.S. Health Care System  How Does Health Care
Reform Address these Issues? (Ira and Roger)
An outline of the health care reform effort
I. Understanding the Clinton approach – give Congress a detailed plan in which
the administration is personally invested, and ask Congress to pass it.
Advantages: Lawmakers and the public know exactly what is being proposed.
Disadvantages: People can object to specific details. Special interests know
who will be hurt. Criticism of inadequate input from public and industry. Failure
of effort damages the Administration’s credibility.
II. Understanding the Obama approach – express general goals rhetorically and
leave the details to Congress, who in turn, leaves the details to the Secretary of
DHHS. Keep your political distance from the proposal. Advantages: Congress
is invested in the outcome. Administration might be protected from fallout if the
effort fails. Disadvantages: Opponents fill in the blanks with worst-case
scenarios. Administration appears to lack expertise/leadership.
III. A list of some interesting topics related to the Patient Protection and Affordable
Care Act (PPACA)
A. What actually happened in its passage
B. Effects on the debt and deficit
a. Dueling cost estimates
b. The 2010 Medicare Trustees’ Report controversy
c. Paul Ryan’s Roadmap
C. The individual mandate
a. Constitutional challenges and repeal efforts
b. The Exchanges
D. Effects on employers
E. Effects on providers
F. Effects on insurers and agents
G. Effects on Medicare beneficiaries
H. Comparative effectiveness research initiatives
Readings
Compare and contrast:
1. Antos, Joseph R., Pauly, Mark V., and Gail R. Wilensky. “Bending the Cost
Curve through Market-Based Incentives,” New England Journal of Medicine
(August 2012). http://www.nejm.org/doi/full/10.1056/NEJMsb1207996
2. Emmanuel, Ezekiel, et al. “A Systemic Approach to Containing Health Care
Spending,” New England Journal of Medicine (August 2012)
http://www.nejm.org/doi/full/10.1056/NEJMsb1205901
3. Oberlander, J. “Throwing Darts: Americans’ Elusive Search for Health Care
Cost Control,” Journal of Health Politics, Policy and Law
36:477-484, 2011.
4
https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeUjhvZzBNMnhMSzA/edit
http://jhppl.dukejournals.org/content/36/3/477.full.pdf+html
Clinton Plan
1. Skocpol, T. “The Rise and Resounding Demise of the Clinton Plan,” Health
Affairs (Spring 1995) http://healthaff.highwire.org/cgi/reprint/14/1/66.pdf.
Optional
1. Dowd, Bryan E. “The Clinton Health Care Reform Proposal: Efficiency,
Fairness and the Role of Government,” Health Care Management: State of
the Art Reviews 1:1 (1994) 1-22.
Obama Plan
1. Kaiser Family Foundation – See summary of new health reform law
(http://www.kff.org/healthreform/upload/8061.pdf) and a guide to the
Supreme Court’s ACA Decisions
(http://www.kff.org/healthreform/upload/8332.pdf).
2. Oberlander, J. “Long Time Coming: Why Health Reform Finally Passed.”
Health Affairs 29:1112-1116, 2010.
http://content.healthaffairs.org/content/29/6/1112.full.pdf+html
3. Rosenbaum, S., Westmoreland, T.M. “The Supreme Court’s Surprise
Decision on the Medicaid Expansion.” Health Affairs 31:1663-1672.
http://content.healthaffairs.org/content/31/8/1663.full.pdf
PPACA
1. Overview of PPACA
The Kaiser Family foundation (http://www.kff.org) has prepared numerous
reports on PPACA. Also see:
https://securews.bcbswny.com/wps/wcm/connect/a55b41804271b8fcaa5afb
b68f905d47/BCBSA_Detailed_Reform_Summary_MASTER_04-2210.pdf?MOD=AJPERES&CACHEID=a55b41804271b8fcaa5afbb68f905d47
and
http://dpc.senate.gov/healthreformbill/healthbill96.pdf
An up-to-date overview of all aspects of PPACA is provided by Jean
Abraham, “The Affordable Care Act on a Stick,” power-point presentation,
August 21, 2013 (we will distribute). You might also try filling out the
application for subsidized individual coverage, which we will provide or send
the link.
2. Dueling Cost Estimates
a. CBO:http://www.cbo.gov/sites/default/files/cbofiles/attachments/03-13Coverage%20Estimates.pdf
b. Rick Foster, CMS:
http://graphics8.nytimes.com/packages/pdf/health/oactmemo1.pdf
c. Jonathan Gruber, “The Impacts of the Affordable Care Act: How
Reasonable Are the Projections?” National Bureau of Economic
Research, NBER Working Paper 17168, June, 2011, available at
http://www.nber.org/papers/w17168.
3. Effects on Medicare
a. Trustees’ Report (Overview): http://www.healthreformgps.org/wpcontent/uploads/tr2012.pdf
b. Rick Foster, CMS:
http://www.economics21.org/commentary/cms-medicare-actuarydisavows-medicare-trustees-report
c. CBO:http://www.cbo.gov/sites/default/files/cbofiles/attachments/43471hr6079.pdf
4. Topic: Effects on Insurers
a. http://www.naic.org/documents/committees_b_Immediate_Improvement
s.pdf
b. Jean M. Abraham and Pinar Karaca-Mandic, “Regulating the Medical
Loss Ratio: Implications for the Individual Market,” American Journal of
Managed Care, 17:3 (2011), 211-218.
http://www.ajmc.com/publications/issue/2011/2011-3-vol17n3/ajmc_11mar_abraham_211to218/1
5
https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeUjhvZzBNMnhMSzA/edit
5. Topic: The Cadillac Tax
a. Bradley Herring and Lisa Korin Lentz, “What Can We Expect from the
“Cadillac Tax” in 2018 and Beyond?” Inquiry, 48:4 (Winter, 2011/2012),
322-327.
http://www.inquiryjournalonline.org/doi/pdf/10.5034/inquiryjrnl_48.04.06
b. Jonathan Gruber and Michael Lettau, “How Elastic is the Firm’s
Demand for Health Insurance?” Journal of Public Economics, 88
(2004), 1273-1293.
http://www.sciencedirect.com/science/journal/00472727/88/7-8
6. Topic: Alternative Visions of Reform
a. Paul Ryan’s Roadmap
http://paulryan.house.gov/News/DocumentSingle.aspx?DocumentID=27
2682
b. Mark V. Pauly, “Lessons to Improve the Efficiency and Equity of Health
Reform,” Hastings Center Report, 42:5 (September-October, 2012), 2124. http://onlinelibrary.wiley.com/doi/10.1002/hast.71/pdf
c. Cosgrove, D.M., Fisher, M., Gabow, P., et al. “Ten Strategies to Lower
Costs, Improve Quality, and Engage Patients: The View from Leading
Health System CEOs,” Health Affairs, 32 (2013) 321-327.
http://content.healthaffairs.org/content/32/2/321.full.pdf+html
d. Other readings will be distributed.
Week 6 – 10/8
Health Care Reform – Continued (Ira and Roger)
State-level Reform:
What are the challenges of establishing health insurance exchanges?
What alternative arrangements are states making?
How are states responding to the potential to expand Medicaid?
Readings
1. Kaiser Family Foundation. “Establishing Health Insurance Exchanges: An
Overview on State Efforts.” August 2012.
http://www.kff.org/healthreform/upload/8213-2.pdf
2. Eibner, C. et al. “Establishing State Health Insurance Exchanges.”
Technical Report, RAND Corporation, 2010.
http://www.rand.org/pubs/technical_reports/2010/RAND_TR825.pdf
3. Dorn, S. “State Implementation of National Health Reform: Harnessing
Federal Resources to Meet State Policy Goals.” Prepared for RWJF’s State
Coverage Initiatives by the Urban Institute, July 2010.
http://www.legis.state.wi.us/lc/committees/study/2010/REFORM/files/dorn_
urbaninstitute.pdf
4. Blumberg, L.J. and Rifkin, S. “State-level Progress on Implementation of
Federally Facilitated Exchanges: Findings in Three Case Studies,” Robert
Wood Johnson Foundation and Urban Institute. June 2013.
http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf406521
5. Dash, S., Lucia, K.W., Keith, K., and Monahan, C. “Implementing the
Affordable Care Act: Key Design Decisions for State-based Exchanges,”
The Commonwealth Fund, July 2013.
http://www.commonwealthfund.org/%7E/media/Files/Publications/Fund%20
Report/2013/Jul/1696_Dash_key_design_decisions_state_based_exchang
es.pdf
6. Stephen T. Parente and Roger Feldman, “Micro-simulation of Private
Health Insurance and Medicaid Take-up Following the U.S. Supreme Court
Decision Upholding the Affordable Care Act,” Health Services Research,
published online February 10, 2013, doi:10.1111/1475-6773.12036.
http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12036/pdf
7. K. Baicker and A. Finkelstein. “The Effects of Medicaid Coverage —
Learning from the Oregon Experiment,” New England Journal of Medicine,
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https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeUjhvZzBNMnhMSzA/edit
365 (2011), 683-385. http://www.nejm.org/doi/pdf/10.1056/NEJMp1108222
8. A. Finkelstein, S. Taubman, B. Wright, et al. “The Oregon Health Insurance
Experiment: Evidence from the First Year,” Quarterly Journal of Economics,
127 (2012), 1057-1106.
http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=3&sid=36fef06ee408-4ff8-8d26-a06394e3cc98%40sessionmgr14&hid=19
Week 7 – 10/15
Standard Explanations for Government Intervention (Roger)
Rosen and Gayer, Part II
1. Public Goods
a. Paul A. Samuelson, “A Pure Theory of Public Expenditure,” Review
of Economics and Statistics, 36 (1954), 387-389.
http://www.jstor.org/stable/pdfplus/1925895.pdf?acceptTC=true
2. Externalities
a. Thomas F. Pogue and Larry G. Sgontz, “Taxing to Control Social
Costs: The Case of Alcohol,” American Economic Review, 79:1
(March, 1989), 235-243.
http://www.jstor.org/stable/pdfplus/1804784.pdf
b. Duggan, Mark, “More Guns, More Crime,” Journal of Political
Economy, 109:5 (2000), 1086-1114.
http://www.jstor.org/stable/pdfplus/10.1086/322833.pdf
c. Activity: We will discuss either the recent increase in the MN
cigarette tax or the “smoker’s surcharge” in the Affordable Care Act.
3. A Positive Theory of Regulation
a. George J. Stigler, “The Theory of Economic Regulation,” Bell Journal of
Economics, 2:1 (Spring, 1971), 3-21.
http://www.jstor.org/stable/pdfplus/3003160.pdf
Week 8 – 10/22
Week 9 – 10/29
Political Ideology: Values and Justice (Ira)
Values and concepts of justice are central to the public policy process and are often
expressed as political ideology. But simply crediting policy initiative to political
ideology ignores the rich heritage of political thought and perspectives on a just
society. The session introduces concepts related to the nature of justice; alternate
perspectives on welfare rights; the contractual basis for a just society; justice and
equality; the connection between justice and utility; justice as a rational choice; how
liberty upsets patterns; from liberty to welfare; the privatization of good; the rule of
law and democracy; post-modern liberalism.
Readings
1. Sterba, J. Justice: Alternative Political Perspectives. Belmont, CA:
Wadsworth Publishing Company, 2003. (Intro, Chapters 1, 2, 5, 8, 9, 10,
11, 12, 14).
Optional
2. Hausman, Daniel M. and Michael S. McPherson. "Taking Ethics Seriously:
Economics and Contemporary Moral Philosophy," Journal of Economic
Literature 31:2 (June 1993) 671-731.
3. Rose-Ackerman, Susan. "Altruism, Nonprofits, and Economic Theory,"
Journal of Economic Literature 34:2 (June, 1996)701-728. (not printed)
Week 10 – 11/5
Redistribution in-Kind and Social Insurance (Roger)
Why do we redistribute income by reducing the price of goods rather than
transferring income? What is the economic perspective on Social Security and
Medicare?
Readings
1. Rosen and Gayer, Chapters 7 through 10
2. Janet Currie and Firouz Gahvari, “Transfers in Cash and In-Kind: Theory
7
https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeUjhvZzBNMnhMSzA/edit
3.
4.
5.
6.
Meets the Data,” Journal of Economic Literature, 46:2 (June, 2008), 333383. http://www.jstor.org/stable/pdfplus/27646992.pdf
Richard J. Zeckhauser, “Optimal Mechanisms for Income Transfer,”
American Economic Review, 61:3, Part 1, (June, 1971), 324-334.
http://www.jstor.org/stable/pdfplus/1813430.pdf
Martin Feldstein, “Rethinking Social Insurance,” American Economic
Review, 95:1 (2005), 1-24. http://www.jstor.org/stable/pdfplus/4132668.pdf
Martin Feldstein, “Prefunding Medicare,” American Economic Review, 89:2
(May, 1999), 222-227. http://www.jstor.org/stable/pdfplus/117110.pdf
David M. Cutler and Louise Sheiner, “Generational Aspects of Medicare,”
American Economic Review, 90:2 (May, 2000), 303-307.
http://www.jstor.org/stable/pdfplus/117240.pdf
Activity: I will distribute an Excel spreadsheet that lets you choose your
approach to solve Medicare’s financial problems.
Week 11 – 11/12
The Politics of Legislation (Ira)
The politics of legislation; the political market for health policies; how ideas or
events became policy issues; problem definition and the primeval policy soup;
policy, political, and problem streams and windows of opportunity; agenda building
and the role of policy entrepreneurs; the government as an interest group; the
expanding role of those inside the administration on policy formation; Congress vs.
the Administration in shaping policy.
 Students are expected to discuss the strengths and weaknesses of
Kingdon’s observations of policy theories.
Readings
1. Kingdon, J. Agendas, Alternatives and Public Policies, Updated 2nd Edition.
Boston: Longman, 2010.
Week 12 – 11/19
Alternative Theories of Legislation and Policy Implementation (Ira)
Alternate theories of legislation; interest group theory; health associations and
demand for legislation; regulation, deregulation and competition as public policy;
types of redistributive legislation; the control of externalities (use Medicare/Medicaid
as example); strategies to enhance policy implementation.
 This session will be devoted to a critical examination of theories and
proposals regarding the major components of health policy formation.
 Students are expected to discuss the strength and weaknesses of
Feldstein’s arguments.
 Why has privatization been embraced as a mechanism for implementing
policies?
Readings
1. Feldstein, P. The Politics of Health Legislation: An Economic Perspective,
3rd Edition (Chapters 1, 2, 7, 8, 13). Ann Arbor, MI: Health Administration
Press, 2006.
2. Longest, B. Health Policymaking in the United States. Fifth Edition.
Chicago, IL: Health Administration Press, 2010. (Chapter 4).
3. Starr, P. “The Meaning of Privatization,” Yale Law & Policy Review, 6
(1988) 6-41. http://www.jstor.org/stable/pdfplus/40239271.pdf
4. Milward, H.B. and Provan, K.G. “Governing the Hollow State,” Journal of
Public Administration Research and Theory, 10 (2000) 359-380.
http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=3&sid=4a8a77a8ec63-4d49-8a29-d575aa77365d%40sessionmgr11&hid=21
Week 13 – 11/26
Taxation and Public Spending (Roger)
How does taxation affect the distribution of income? How do the concepts of equity
and efficiency apply to taxation? How does public spending on health care
(Medicare and Medicaid) affect the economy?
8
https://docs.google.com/a/umn.edu/file/d/0B7LWJ83cOEeeUjhvZzBNMnhMSzA/edit
Readings
1. Rosen, Chapters 12-19
2. Mitchell, Daniel J. “The Impact of Government Spending on Economic
Growth,” Heritage Foundation Backgrounder #1831, March 31, 2005, and
“The Impact of Government Spending on Economic Growth: Answering the
Critics,” Heritage Foundation Backgrounder #2354, January 5, 2010.
http://s3.amazonaws.com/thf_media/2010/pdf/bg_2354.pdf
a. http://www.takeonit.com/question/264.aspx
b. http://www.slate.com/id/2279721/
c. http://familiesusa2.org/assets/pdfs/Medicaid-Cuts-Hurt-StateEconomies.pdf
3. Ramey, Valerie A. “Can Government Purchases Stimulate the Economy?”
Journal of Economic Literature 49:3 (September 2011) 673-685.
http://pubs.aeaweb.org/doi/pdfplus/10.1257/jel.49.3.673
4. Dowd, Bryan, “The Bush Administration’s Health Insurance Tax Reform
Proposal: A Second Look,” American Enterprise Institute (Sept 2007),
available at http://www.aei.org/outlook/26768
5. Tax expenditures: A review and analysis. Joint Economic Committee, U.S.
House of Representatives. http://www.house.gov/jec/fiscal/tax/expend.htm
6. McNulty, John K. “Flat Tax, Consumption Tax, Consumption-Type Income
Tax Proposals in the United States: A Tax Policy Discussion of
Fundamental Tax Reform,” California Law Review. 88 (2000) 2095.
http://www.jstor.org/stable/pdfplus/3481214.pdf?acceptTC=true
Week 14 – 12/3
Philosophic Perspectives on The Allocation Of Resources to and within the
Health Care Sector (Ira)
Is health care different; extending Rawls theory to health; when is access to health
care equal; doing justice to both providers and consumers; risk and opportunity;
how much protection is too much?
 This session addresses one of the main issues in the theoretical policy
sciences model: What distribution of resources and rights is fair and
equitable and who should decide on that distribution?
 Students should be prepared to discuss how Daniel’s work relates many of
Sterba’s concepts to the health care field and how these concepts are
shaping current health policy discussions at the national level.
Readings
1. Daniels, N. Just Health Care. New York: Cambridge University Press,
Chapters 1-5, 1985.
2. Daniels, N., Soloner, B., and Gelpi, A. “Access, Cost, and Financing:
Achieving An Ethical Health Reform.” Health Affairs – Web Exclusive,
August 18, 2009. http://content.healthaffairs.org/content/28/5/w909.full.html
3. Denier, Y. “On Personal Responsibility and the Human Right to
Healthcare.” Cambridge Quarterly of Healthcare Ethics 14:224-234, 2005.
http://journals.cambridge.org/action/displayFulltext?type=1&pdftype=1&fid=
290038&jid=CQH&volumeId=14&issueId=02&aid=290036
4. Oberlander, J. “Health Reform Interrupted. The Unraveling of the Oregon
Health Plan.” Health Affairs 26:w96-w105, 2007.
http://content.healthaffairs.org/content/26/1/w96.full.pdf+html?sid=beb4646
6-01d6-41ce-bc57-6d96cdedeccf
5. Murtaugh, L. and Ludwig, D. “State Intervention in Life Threatening
Childhood Obesity.” JAMA 3006:206-207, 2011. http://jama.amaassn.org/content/306/2/206.full.pdf+html
Week 15 – 12/10
The Role of the Budget Process in Policy Formation (Ira)
The role of agencies; congressional committee structure; alternate approaches to
determining need; contingent strategies; capitalizing on the fragmentation of power
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in national politics; theory of budgeting; the politics of budget reform; budget
balancing and reconciliation; entitlements and budgeting; the budget act; deficits
and surpluses.
 This session focuses on two main policy formation concepts; the role of the
budgetary process in shaping polices and the degree to which this process
can be improved through program planning and the use of quantitative
methods.
 Students are expected to describe how the budget process shapes policies
and whether theories of program planning and budgeting clash with
Feldstein’s theories of legislation.
 Students should also be able to discuss the strengths and weaknesses of
Lindblom’s alternate theory termed “muddling through” and contrast it with
program planning and budgeting theories.
Readings
1. Wildavsky, A. and Caiden, N. The New Politics of the Budgetary Process,
4th Edition, (Chapters 1, 3, 4, 6, 8, 11). Glenview, IL: Scott, Foresman,
2000.
2. Lindblom. C. “The Science of Muddling Through,” Public Administration
Review 19:79-88, 1959. http://www.jstor.org/stable/pdfplus/973677.pdf
VII. Evaluation and Grading
Grading Criteria
Letter grades and associated points are awarded in this course as follows below, and will appear on the
student’s official transcript.
A 4.0
A- 3.67
B+ 3.33
B 3.00
B- 2.67
C+ 2.33
C 2.00
C- 1.67
D+ 1.33
D 1.00
F 0.00
Represents achievement that is outstanding relative to the level necessary to meet course
requirements
Represents achievement that is significantly above the level necessary to meet course
requirements
Represents achievement that meets the course requirements in every respect
Represents achievement that is worthy of credit even though it fails to meet fully the
course requirements
Represents failure and signifies that the work was completed but not at a level of
achievement worthy of credit
Course Evaluation
Beginning in fall 2008, the SPH will collect student course evaluations electronically using a software system
called CoursEval: www.sph.umn.edu/courseval. The system will send email notifications to students when
they can access and complete their course evaluations. Students who complete their course evaluations
promptly will be able to access their final grades just as soon as the faculty member renders the grade in
SPHGrades: www.sph.umn.edu/grades. All students will have access to their final grades through OneStop
two weeks after the last day of the semester regardless of whether they completed their course evaluation or
not. Student feedback on course content and faculty teaching skills are an important means for improving our
work. Please take the time to complete a course evaluation for each of the courses for which you are
registered.
Incomplete Contracts
A grade of incomplete “I” shall be assigned at the discretion of the instructor when, due to extraordinary
circumstances (e.g., documented illness or hospitalization, death in family, etc.), the student was prevented
from completing the work of the course on time. The assignment of an “I” requires that a contract be initiated
and completed by the student before the last official day of class, and signed by both the student and
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instructor. If an incomplete is deemed appropriate by the instructor, the student in consultation with the
instructor, will specify the time and manner in which the student will complete course requirements.
Extension for completion of the work will not exceed one year (or earlier if designated by the student’s
college). For more information and to initiate an incomplete contract, students should go to SPHGrades at:
www.sph.umn.edu/grades.
University of Minnesota Uniform Grading and Transcript Policy - A link to the policy can be found at
onestop.umn.edu.
VIII. Other Course Information and Policies
Grade Option Change (if applicable)
For full-semester courses, students may change their grade option, if applicable, through the second week of
the semester. Grade option change deadlines for other terms (i.e. summer and half-semester courses) can
be found at onestop.umn.edu.
Course Withdrawal
Students should refer to the Refund and Drop/Add Deadlines for the particular term at onestop.umn.edu for
information and deadlines for withdrawing from a course. As a courtesy, students should notify their
instructor and, if applicable, advisor of their intent to withdraw.
Students wishing to withdraw from a course after the noted final deadline for a particular term must contact
the School of Public Health Office of Admissions and Student Resources at sph-ssc@umn.edu for further
information.
Student Conduct Code
The University seeks an environment that promotes academic achievement and integrity, that is protective of
free inquiry, and that serves the educational mission of the University. Similarly, the University seeks a
community that is free from violence, threats, and intimidation; that is respectful of the rights, opportunities,
and welfare of students, faculty, staff, and guests of the University; and that does not threaten the physical or
mental health or safety of members of the University community.
As a student at the University you are expected adhere to Board of Regents Policy: Student Conduct Code.
To review the Student Conduct Code, please see:
http://regents.umn.edu/sites/default/files/policies/Student_Conduct_Code.pdf.
Note that the conduct code specifically addresses disruptive classroom conduct, which means "engaging in
behavior that substantially or repeatedly interrupts either the instructor's ability to teach or student learning.
The classroom extends to any setting where a student is engaged in work toward academic credit or
satisfaction of program-based requirements or related activities."
Use of Personal Electronic Devices in the Classroom
Using personal electronic devices in the classroom setting can hinder instruction and learning, not only for
the student using the device but also for other students in the class. To this end, the University establishes
the right of each faculty member to determine if and how personal electronic devices are allowed to be used
in the classroom. For complete information, please reference:
http://policy.umn.edu/Policies/Education/Education/STUDENTRESP.html.
Scholastic Dishonesty
You are expected to do your own academic work and cite sources as necessary. Failing to do so is
scholastic dishonesty. 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. (Student Conduct Code:
http://regents.umn.edu/sites/default/files/policies/Student_Conduct_Code.pdf) If it is determined that a student has
cheated, he or she may be given an "F" or an "N" for the course, and may face additional sanctions from the
University. For additional information, please see:
http://policy.umn.edu/Policies/Education/Education/INSTRUCTORRESP.html.
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The Office for Student Conduct and Academic Integrity has compiled a useful list of Frequently Asked
Questions pertaining to scholastic dishonesty: http://www1.umn.edu/oscai/integrity/student/index.html. If you
have additional questions, please clarify with your instructor for the course. Your instructor can respond to
your specific questions regarding what would constitute scholastic dishonesty in the context of a particular
class-e.g., whether collaboration on assignments is permitted, requirements and methods for citing sources,
if electronic aids are permitted or prohibited during an exam.
Makeup Work for Legitimate Absences
Students will not be penalized for absence during the semester due to unavoidable or legitimate
circumstances. Such circumstances include verified illness, participation in intercollegiate athletic events,
subpoenas, jury duty, military service, bereavement, and religious observances. Such circumstances do not
include voting in local, state, or national elections. For complete information, please see:
http://policy.umn.edu/Policies/Education/Education/MAKEUPWORK.html.
Appropriate Student Use of Class Notes and Course Materials
Taking notes is a means of recording information but more importantly of personally absorbing and
integrating the educational experience. However, broadly disseminating class notes beyond the classroom
community or accepting compensation for taking and distributing classroom notes undermines instructor
interests in their intellectual work product while not substantially furthering instructor and student interests in
effective learning. Such actions violate shared norms and standards of the academic community. For
additional information, please see: http://policy.umn.edu/Policies/Education/Education/STUDENTRESP.html.
Sexual Harassment
"Sexual harassment" means unwelcome sexual advances, requests for sexual favors, and/or other verbal or
physical conduct of a sexual nature. Such conduct has the purpose or effect of unreasonably interfering with
an individual's work or academic performance or creating an intimidating, hostile, or offensive working or
academic environment in any University activity or program. Such behavior is not acceptable in the
University setting. For additional information, please consult Board of Regents Policy:
http://regents.umn.edu/sites/default/files/policies/SexHarassment.pdf
Equity, Diversity, Equal Opportunity, and Affirmative Action
The University will provide equal access to and opportunity in its programs and facilities, without regard to
race, color, creed, religion, national origin, gender, age, marital status, disability, public assistance status,
veteran status, sexual orientation, gender identity, or gender expression. For more information, please
consult Board of Regents Policy: http://regents.umn.edu/sites/default/files/policies/Equity_Diversity_EO_AA.pdf.
Disability Accommodations
The University of Minnesota is committed to providing equitable access to learning opportunities for all
students. Disability Services (DS) is the campus office that collaborates with students who have disabilities to
provide and/or arrange reasonable accommodations.
If you have, or think you may have, a disability (e.g., mental health, attentional, learning, chronic health,
sensory, or physical), please contact DS at 612-626-1333 to arrange a confidential discussion regarding
equitable access and reasonable accommodations.
If you are registered with DS and have a current letter requesting reasonable accommodations, please
contact your instructor as early in the semester as possible to discuss how the accommodations will be
applied in the course.
For more information, please see the DS website, https://diversity.umn.edu/disability/.
Mental Health and Stress Management
As a student you may experience a range of issues that can cause barriers to learning, such as strained
relationships, increased anxiety, alcohol/drug problems, feeling down, difficulty concentrating and/or lack of
motivation. These mental health concerns or stressful events may lead to diminished academic performance
and may reduce your ability to participate in daily activities. University of Minnesota services are available to
assist you. You can learn more about the broad range of confidential mental health services available on
campus via the Student Mental Health Website: http://www.mentalhealth.umn.edu.
Academic Freedom and Responsibility: for courses that do not involve students in research
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Academic freedom is a cornerstone of the University. Within the scope and content of the course as defined
by the instructor, it includes the freedom to discuss relevant matters in the classroom. Along with this
freedom comes responsibility. Students are encouraged to develop the capacity for critical judgment and to
engage in a sustained and independent search for truth. Students are free to take reasoned exception to the
views offered in any course of study and to reserve judgment about matters of opinion, but they are
responsible for learning the content of any course of study for which they are enrolled.*
Reports of concerns about academic freedom are taken seriously, and there are individuals and offices
available for help. Contact the instructor, the Department Chair, your adviser, the associate dean of the
college, or the Vice Provost for Faculty and Academic Affairs in the Office of the Provost. [Customize with
names and contact information as appropriate for the course/college/campus.]
* Language adapted from the American Association of University Professors "Joint Statement on Rights and
Freedoms of Students".
Template update 9/2013
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