Politics and Policies in the U.S. Health Care System
HIS 373W/PM 420
Medical Center 3-6408 (K-307)
Fall 2015
Instructor: Theodore M. Brown (Theodore_Brown@urmc.rochester.edu)
Office Hours: Monday 11:00-1:00 in Rush Rhees 368, and by appointment in both Rush Rhees
and Saunders Research Building 3125
Course Synopsis:
This course examines the formation and evolution of American health policy from a political and
historical perspective. Concentrating on developments from the early twentieth century to the
present, the focus of readings and discussions will be political forces and institutions and
historical and cultural contexts. Among the topics covered are periodic campaigns for national
health insurance, efforts to rationalize and regionalize health care institutions, the creation of
Medicare and Medicaid and the further evolution of these programs, the rise to dominance of
economists and economic analysis in the shaping of health policy, incremental and state-based
vs. universal and federal initiatives, the formation and failure of the Clinton administration’s
health reform agenda, health reform in the George W. Bush administration and the 2008
presidential campaign, and national health reform and pushback during the Obama
administration.
Learning Objectives:
1. Identify the main components and issues in the organization, financing and delivery of
health services in the United States
2. Discuss the American policy process for improving access to personal health services and
the health status of populations
3. Describe the historical foundations and current ethical bases for U.S. health services
Required Books:
Starr, Paul - THE SOCIAL TRANSFORMATION OF AMERICAN MEDICINE
Benjamin, Georges, Brown, Theodore, et al. – THE QUEST FOR HEALTH REFORM: A
SATIRICAL HISTORY
Copies of both books are available at the Barnes & Noble bookstore in College Town. All other
readings will be available on Blackboard or via Voyager electronic access.
Seminar Participation and Grading:
This is a seminar course in which active, well-prepared student participation is expected. The
other major requirements are two 5-page take-home essay-exams and a 10-page research paper.
The first take-home essay will be due October 20; the second on December 1. Essay-exam topics
will be announced in advance. The topic and approach of the research paper should be discussed
in detail with the instructor. The final draft is due no later than Monday, December 14. Course
grades will be determined as follows: take-home essays – 20% each; term paper – 45%;
contribution to seminar discussion – 15%.
Academic Honesty: All assignments and activities associated with this course must be performed
in accordance with the University of Rochester’s Academic Honesty Policy. More information is
available at: www.rochester.edu/college/honesty(index.html)
Seminar Schedule - Fall 2015
1. Introduction and Orientation (9/1)
Starr, Social Transformation, pp. 79-144 [optional but useful]
2. Early Battles Over Medical Care (9/8)
Starr, Social Transformation, pp. 235-266
Benjamin, Brown et al., Quest for Health Reform, pp. 1-14
Committee on the Costs of Medical Care, Medical Care for the
American People, pp. v-xii, 104-144, 152-183, 201
3. Health Politics from the New Deal to the Cold War (9/15)
Starr, Social Transformation, pp. 266-289
Benjamin, Brown et al., Quest for Health Reform, pp. 15-19
Thomas Kochan et. al., The Transformation of American Industrial
Relations, pp. 21-46
Dan Feshbach, "What's Inside the Black Box: A Case Study of Allocative Politics in
the Hill-Burton Program," Int. J. Health Services, 9 (1979), pp. 313-339
4.
Development of the American System of Employment-Based Health Insurance (9/22)
Starr, Social Transformation, pp. 290-334
Starr, Remedy and Reaction, pp. 35-50 [Voyager electronic access]
Stephen Strickland, "Integration of Medical Research and Health Policies," Science,
173 (1971), pp. 1093-1103
5. Medicare, Medicaid, and their Implications (9/29)
Starr, Social Transformation, pp. 363-378
Benjamin, Brown et al., Quest for Health Reform, pp. 20-27
David J. Rothman, “A Century of Failure: Health Reform in America,” Journal of
Health Politics, Policy and Law, 18 (1993), pp. 271-286
Bruce Vladeck, “Medicare and the Politics of Incrementalism,” Journal of Health
Policy, Politics, and Law, 26 (2001), pp. 153-160
6. Rising Costs, "Crisis," and Personal Responsibility (10/13)
Starr, Social Transformation, pp. 379-393, 408-411
Robert Crawford, "Individual Responsibility and Health Politics in the 1970s,"
in Susan Reverby and David Rosner (eds.), Health Care in America, pp. 247-268
John Knowles, "The Responsibility of the Individual," in John Knowles (ed.),
Doing Better and Feeling Worse, pp. 57-80
John B. McKinlay and Sonja M. McKinlay, "The Questionable Contribution of
Medical Measures to the Decline of Mortality in the United States in the
Twentieth Century," The Milbank Quarterly, 55 (1977), pp. 405-428
7. Health Policy in the Seventies (10/20)
Starr, Social Transformation, pp. 393-408
Daniel Fox, "Health Policy and the Politics of Research in the United States," Journal
of Health Politics, Policy and Law, 15 (1990), pp. 481-499
John Wennberg and Alan Gittelsohn, "Small Area Variations in Health Care Delivery,"
Science, 182 (1973), pp. 1102-1108
Evan Melhado, "Economists, Public Provision, and the Market: Changing Values in
Public Debate," Journal of Health Politics, Policy and Law, 23 (1998), pp. 215-263
[read selectively]
8. The New Health Care “Market” (10/27)
Starr, Social Transformation, pp. 408-444
Clark C. Havighurst, "Controlling Health Care Costs: Strengthening the Private Sector's
Hand," Journal of Health Politics, Policy and Law, 1 (1976), pp. 471-498
Alain C. Enthoven, "Consumer-Choice Health Plan," (Part I), New England Journal of
Medicine, 298 (1978), pp. 650-658
Alain C. Enthoven, "Consumer-Choice Health Plan," (Part II), New England Journal
of Medicine, 298 (1978), pp.709-720
David A. Stockman, “Premises for a Medical Marketplace, Health Affairs, 1 (1981),
pp. 5-18
9. The Eighties: Health Care Consequences (11/3)
Nicole Lurie et. al., "Termination from Medi-Cal: Does It Affect Health?", New
England Journal of Medicine, 311 (1984), pp. 480-484
Arden Miller, “Infant Mortality in the U.S.,” Scientific American, 253 (July 1985),
pp. 31-35
Gregory L. Lindberg et. al., "Health Care Cost Containment Measures and Mortality,"
Am. J. Public Health, 79 (1989), pp. 1481-1485
Benjamin et al., Quest for Health Reform, pp. 28-30
10. National Health Insurance Revisited - I (11/10)
Vicente Navarro, “The Rediscovery of the National Health Program by the Democratic
Party of the United States,” International Journal of Health Services, 19 (1989), pp. 1-18
Emily Friedman, "The Uninsured: From Dilemma to Crisis," JAMA, 265 (1991),
pp. 2491-2495
Marcia Angell et. al., "The Presidential Candidates and Health Care Reform,”
New England Journal of Medicine, 327(1992), pp. 800-811
Benjamin et al., Quest for Health Reform, pp. 30-34
11. National Health Insurance Revisited - II (11/17)
American Medical Association, "The AMA's Analysis of the Clinton Plan," (September
1993)
Benjamin, Brown et al., Quest for Health Reform, pp. 34-43
Starr, Remedy and Reaction, pp. 103-128
Vicente Navarro, "The Politics of Health Care Reform in The United States, 1992-1994:
A Historical Review," International Journal of Health Services, 25 (1995), pp. 185-201
12. From Clinton to the Present (11/24, 12/1, 12/8)
Benjamin, Brown et al., Quest for Health Reform, pp. 43-174
Bruce Vladeck “Universal Health Insurance in the United States: Reflections on the Past,
Present, and the Future,” American Journal of Public Health, 93 (2003), pp. 16-19
Starr, Remedy and Reaction, pp. 129-281