COLLEGE OF HEALTH AND HUMAN SERVICES
California State University, Long Beach
Health Care Administration Program
HCA 202 – Healthcare in America
Fall 2009
Instructor: Grace Reynolds, D.P.A.
E-mail: GREYNOL2@csulb.edu
Office Hours: T 10-11AM; 3:30-5:30
Phone: 562-985-5885
Class Number: 6442
Class Meets: T/TH 11-12:15PM
Room: SPA 208
HCA Program Administrative Coordinator:
Deby McGill, dmcgill@csulb.edu
Tel. 562/985-5694; fax 562/985-5886
Course Description: This course provides a critical analysis of the American healthcare system,
in comparison and contrast with Japanese and European systems, and examines alternatives for
improvement of cost, quality and access. Through interactive discussion of assigned readings and
individual projects, students will learn about the major components of the healthcare system and
critically examine today’s major health policy issues in their historical, economic and political
context, including the system’s market and government failures and past and current efforts at
health care reform.
Catalogue Description: US health care system with its delivery and financing mechanisms as
well as the technical, economic, political and social forces responsible for changes in the health
care system. Contemporary issues will be analyzed such as access, cost and quality, health
disparities among minority groups as well as gender disparities including sexual orientation.
Expected Objectives and Outcomes:
1. Learn to think critically and to ask questions. How has Obama’s concept of social justice
influenced how he talks about health care reform? Do you agree with the text that
“market justice results in the unequal allocation of health care services” (page 15)? Is
“ObamaCare” real reform or is it an unaffordable, soon to be overused, government
entitlement program? Does U.S. have a health care system or an unconnected cottage
industry of body repair services?
2. Describe how environmental, economic, social and political forces affect access to health
care in America.
3. Identify the components of the health care continuum, with an emphasis on primary care
and hospital care, but with attention also to the growing importance of long term care.
4. Understand the theory and advantages of integrated and managed care, including
developments in disease and case management.
5. Understand the development of the concept of the medical home as a process for
integrating care http://en.wikipedia.org/wiki/Medical_home .
6. Appreciate the diversity of needs of special populations, including the mentally ill,
disabled, homeless and those facing language and cultural barriers and same sex
orientation.
1
7. Discuss the problems of the uninsured in accessing care, why the uninsured population is
so large in the U.S. mixed market system and the several alternative policy options for
addressing the problem.
8. Understand the basic market and government failures that have contributed to the long
term increase in health care costs and the reasons this trend is not sustainable.
9. Understand the distinction between public health and personal medical care and the
distinct role of each in life expectancy and infant mortality.
10. Appreciate how terrorism and emergency-preparedness have increased the importance of
partnerships between public health and Department of Justice, Food and Drug
Administration, and volunteer organizations such as the American Red Cross.
11. Define the major health care professions and the role of health care administrators within
each. Identify skills and competencies required for various health care jobs. Discuss the
growth projections for health care employment and the Health Care Administration
major.
Required Text: Shi, Leiyu and Douglas A. Singh. 2010. Essentials of the US Health Care
System. Boston: Jones and Bartlett. (The supplement is not required).
Supplemental required readings (supplied by Instructor):
Lewin Group, July 2009. “Analysis of the July 15, 2009 Draft of the American
Affordable Health Choices Act.”
Survey: “The Health of Nations.” The Economist. (July 15, 2004). All nine parts in the
survey will be posted on BeachBoard along with my PowerPoint.
Friedman, Milton. 2001. “How to Cure Healthcare.” www.thepublicinterest.com posted
on BeachBoard along with my PowerPoint.
Feldstein, Paul J. 2007. Health Policy Issues: An Economic Perspective. Fourth edition.
Chicago: Health Administration Press. (Selected chapters posted on BeachBoard).
Goldhill, David. 2009. “How American Health Care Killed My Father.” The Atlantic.
September.
Laffer, Arthur B. 2009. “How to Fix the Health Care ‘Wedge.’” Wall Street Journal.
August 5.
Sowell, Thomas. 2005. Basic Economics: A Citizen’s Guide to the Economy. Chapter 6:
“The Role of Profits and Losses” posted on BeachBoard along with my PowerPoint.
Stonebraker, Robert J. The Joy of Economics: Making Sense Out of Life.
http://faculty.winthrop.edu/stonebrakerr/book/medicalcare.htm
Video materials:
2
“IOUSA” http://www.youtube.com/watch?v=O_TjBNjc9Bo
“Remaking American Medicine”: PBS Home Video
Reid, T.R. Interview on NPR regarding his book The Healing of America: A Global
Quest for Better, Cheaper, and Fairer Health Care. Listen to interview here:
http://www.npr.org/templates/story/story.php?storyId=112172939.
Reid, T.R. “Sick Around the World” PBS Home Video.
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
Stossel, John “Sick in America” (Six Part Series) ABC News 20/20
http://www.youtube.com/watch?v=E_KCLm9cekU&feature=related
Stossel, John. 2006. “Stupid in America” ABC News Series.
http://www.youtube.com/watch?v=Bx4pN-aiofw
“Univeral Health Care in the United States: Three Approaches.” Woodrow Wilson
International Center for Scholars. October 3, 2007.
http://www.wilsoncenter.org/index.cfm?topic_id=116811&fuseaction=topics.event_sum
mary&event_id=241825#
Student Assignments and Grading
Measurement Tool
I.
Critical essay and presentation
II.
Quizzes (total of 6@ 20 pts each)
III
Final exam
IV.
Attendance/participation (up to 25 total @ 1 pt
Per class day)
Total Points
90% +
80-89%
70-79%
60-69%
<60
Total points available
100
120
100
25
345
A
B
C
D
F
CRITICAL ESSAY GUIDELINES
Introduction
The heart of this class is the essay. Many of us today are overwhelmed with electronic media,
have the attention span of a nanosecond and have lost, or you never developed, the ability to
think deeply and analyze critical options. Google lists 6,120,000 entries on the subject of “health
care reform.” The internet is drinking from a fire hose. It is not scholarship. The future requires
thinkers. In this class you will think.
What is a critical essay?
3
A critical essay reflects critical thinking http://en.wikipedia.org/wiki/Critical_thinking. It forces
you to ponder deeply. It provokes and reflects thought. It examines solutions from multiple
perspectives. It thinks through both market and government failure, including how a program is
implemented and how and how it is evaluated for cost-effectiveness.
Look at Both Sides: Look for the Fight
Use competing journal articles, competing views from think tanks, competing views in political
debates, etc. Democrats are not right and Republicans wrong or visa-versa. The truth is more
complicated.
Presenting Your Analysis
You will be orally summarizing your position and findings in a short essay for your classmates
that ends by asking them a question for discussion. Outline your key points on a single sheet to
hand to me prior to your talk. These presentations must be short (5 minutes or less) and allow no
more than five minutes for discussion.
Length and Format
Take a chance and buy a print newspaper paper. Look at the page opposite to the editorial page
of the Los Angeles Times or the Wall Street Journal. These “op-ed” pieces are often great
examples of fact and data-based argument. We are not interested in cheap polemics, but in strong
supported reasoning. Three pages double-spaced (your references add a fourth page) should be
adequate to present your argument. Be brief but specific and make your report data and factladen. Limit personal opinion. I love charts and graphs that illustrate your point.
References
You must include at least two academic (peer reviewed) references (books, journal articles) in
addition to the texts. Use a consistent and standard reference protocol. Newspaper and magazine
articles that inform your understanding may be cited but do not count toward journal article
requirement. Please visit library to get acquainted with Health Affairs and other journals of the
health care field.
Essay Topics Concerning the Historic Obama-Era Health Care Reform:
Usually I allow students to write on all areas covered in the text. But this year, with the reform
debate raging and the result of debate so key to how you will get health care in the future, I am
suggesting that all essays focus on some area of reform:
 Massachusetts health care reform. This “mandate” program was an inspiration for
ObamaCare. But is it working or it is just leading to higher costs and taxes?
 Federalism and health care. Should we have created successful state reforms before
going national? Should the nation have one health system or it is better that each state be
different?
 Market failures. Discuss one or more of the specific market failures that the government
is attempting to correct in reform. Which failures will be reduced? Will reform make any
worse?
 Government failures. What are the possible government failures and unintended
consequences in implementation of Obama reforms?
4









Medicare/Medicaid unfunded liabilities. The Medicare/Medicaid unfunded liabilities
(or impending bankruptcy) and the effect on Obama reforms.
Increased demand. Will the Obama reforms increase the demand for health care (or
control it?).
Your choice. Consumer choice and empowerment: has Obama hurt or helped it?
Politics of reform. Stakeholders and interest groups favoring and opposing the Obama
reforms.
Rationing. Every health system in the world rations care. Care is rationed in our existing
quasi-market system. Is rationing of health care under Obama just a scare tactic of
opponents or a more rational solution to allocation of scare resources?
The “public option.” Is the government a competitor or a predator? Does the “public
option” act to “keep insurance companies honest” or does it displace private insurance for
millions of workers with a government insurance system that is subsidized with tax
dollars? Is it designed as a step to “single payer?”
Single payer or mandate? Obama states that he prefers single-payer system but was
forced by politics into accepting a mandate system. Which is better? Why/
What will Obama Care cost? Why did the CBO scoring of the House bill result in
sticker shock? What was Medicare supposed to cost when enacted? What were the results
after five years? Has Medicare cost been controlled now?
Profit. Even the Republican Party is shunning the use of the term “profit” in health care.
Why? Every not-for-profit organization (hospital, etc.) must make a profit or go broke.
Profit allows new drugs to be researched and developed. If government financed all
health care to eliminate profit would the system be more efficient? More innovative?
Expectations of Student Skill Performance
To complete the requirements for the course, students are expected to:
Write clearly and concisely, using correct grammar, punctuation and spelling.
Communicate articulately in oral presentations.
Be proficient in using PowerPoint for presentations.
Search the web and research publication, then apply the information found.
Analyze information, both numeric and text.
Apply internationally-accepted metrics to compare health and healthcare.
Synthesize information about factors that impact health and health care.
Compare and contrast countries, situations, historic and current times.
Participate in class discussions.
Submit all assignments on time.
Submit assignments on line and provide professor with a paper copy during class.
Student Responsibilities and University Policies
(1) CSULB policies on cheating and plagiarism shall apply, as delineated in California State
University, Long Beach Policy Statement 85-19, December 13, 1985. One or more of the
following academic actions are available to the faculty member who finds a student has been
cheating or plagiarizing.
(a) Review -- no action.
5
(b) An oral reprimand with emphasis on counseling toward prevention of further
occurrences;
(c) A requirement that the work be repeated;
(d) Assignment of a score of zero (0) for the specific demonstration of
competence, resulting in the proportional reduction of final course grade;
(e) Assignment of a failing final grade;
(f) Referral to the Office of Judicial Affairs for possible probation, suspension, or
expulsion.
(2) Students who need accommodation for any type of disability must inform the instructor in
advance.
(3) Withdrawal is the responsibility of student. Withdrawal after the posted date is allowed only
for serious and compelling reasons and requires the approval of the dean.
(4) Absences are excused consistent with University policies.
(5) Students are expected to have CSULB email accounts and to check their email and
BeachBoard regularly for class announcements and for additional required articles.
Use of Academic Technology in this Class
This course makes use of several forms of academic technology, including the web, e-reserves
and BeachBoard. Students are required to use of this technology to fulfill the requirements for
this course. To participate in the academic technology elements of this course, students must
have access to, and be able to use:
 A computer, equipped with Adobe Acrobat Reader 5.0 or newer and word-processing
software capable of reading Microsoft Word XP files.
 The internet. Specifically, the World Wide Web. Whatever internet service provider is
used must be capable of accessing Web pages, BeachBoard and Acrobat files.
 An account on BeachBoard.
No Use of Cell Phones and Laptops in Class
There will be absolutely no text messaging, internet or laptop use during class instruction, even
for note taking. Any appearance of a cell phone during exams will be a presumption of cheating
and zero points will be assigned. Please leave all electronic devices outside the classroom or
contained in your backpacks.
Communicating With the Instructor
Please sign any emails sent to the instructor with your full name. Instructor will not respond to
unsigned emails. Be advised that the instructor often cannot figure out who you are by your
email address; addresses such as cheesegirl45@yahoo.com or blondecowboyinLA@gmail.com
are cute but do not provide any clues as to the identity of the sender. Please allow from 48-36
hours for instructor to respond, especially during the first and last months of the semester.
6
The Library E-Reserve System
Other readings and materials will be available on the CSULB Library’s E-Reserve system. To
access the system type the following address in your web browser: eReserves.library.csulb.edu.
Type “Tradewell” in the space for “ERes QuickSearch” and click on the “search” button. You
will then see the course password page. Enter the password for the course, which is “think,”
and then click on the “accept” button. You should now be in the main course folder. You will
see a folder titled “Readings,” click on it and you will see each reading. Click on the reading and
you can read the article on screen or download and print it.
The 2009 Health Care Reform Debate
“Like its predecessors, the Obama administration treats additional government funding as a
solution to unaffordable health care, rather than its cause.”
--David Goldhill, The Atlantic, September 2009.
“Aside from race, health care is the most difficult domestic issue of the past century.”
--Paul Begala, Washington Post interview, August 12, 2009.
“What a disaster this health-care debate is. It strains, stresses and pierces, it unnecessarily
agitates and is doomed to be the cause of further agitation. Who doubts the final bill will be
something between a pig in a poke and three-card Monte?”
--Peggy Noonan, WSJ, August 15, 2009
"The problem with socialism is that eventually you run out of other people's money." --Margaret
Thatcher
“But for all the scare tactics out there, what’s truly scary — truly risky — is the prospect of
doing nothing. If we maintain the status quo, we will continue to see 14,000 Americans lose their
health insurance every day. Premiums will continue to skyrocket. Our deficit will continue to
grow. And insurance companies will continue to profit by discriminating against sick people.”
--President Obama, New York Times, August 16, 2009
Tentative Class Schedule Fall 2009
NOTE: Only text chapters are shown below. Supplemental readings are posted each week
on BeachBoard at least two weeks before each class meeting. I will test on any materials
that are posted regardless of whether they are discussed in class. Do your readings before
class to understand what is being discussed.
Class # Day/Date
Topic
Text Reading
Class Work
Assignments
1
PowerPoint:
Read assignments
Sept. 1
Introduction
Ten differences on BeachBoard
in U.S.
healthcare
7
2
ObamaCare
Sept. 3
Chapter 1;
BeachBoard
readings.
Should we drive
profit out of HC?
Closed Sept. 8
campus
3
Sept. 10
No Class
Beliefs, Values
and “Rights”
Chapter 2;
4
Sept. 15
Financing
Chapter 6
5
Sept. 17
Chapter 3
6
Sept. 22
Evolution of
Healthcare
Alternative
solutions
Chapter 3
Quiz 1 chapters
1,2,6
7
Sept. 24
Healthcare
Professionals
Chapter 4
Feinstein’s
Chapter 24: Nurse
Shortage
8
9
10
11
Sept. 29
Oct. 1
Oct 6
Oct. 8
12
Oct. 13
13
Oct. 15
14
Oct. 20
NO CLASS
15
16
Oct. 22
Chapter 7
Chapter 8
17
Financing &
Reimbursement
Outpatient
Services
Inpatient Services
Oct. 27
Oct. 29
18
19
20
Technology
Nov. 3
Nov. 5
21
Nov. 10
Nov. 12
22
Nov. 17
23
Nov. 19
Chapter 4
FLU Video
Chapter 5
Chapter 5
Official Campus
Furlough Day
Guide:
Public/Private
Goods
Deadweight tax
loss
Quiz 1 Review
Quiz 2 Review
Quiz 2; Chapters
1-6
Chapter 6
Chapter 7
NO Class
Managed Care
Chapter 9
Long Term Care
Chapter 10
Chapter 10
Special
Populations
Cost, Access,
Quality
Chapter 11
Library Day for
work on paper
Quiz 3; Chapter
7-8
Library Day to
work on paper
Quiz 4 Review
Quiz 4 on
Chapter 9-10
Chapter 12
Chapter 12
Review for quiz 5
8
24
Nov. 24
Critical Essay
due
Closed Nov. 26
campus
25
Dec. 1
No Class
26
Dec. 3
Bioterrorism
Future of Health
Care
27
Dec. 8
28
Dec. 10
Policy
Happy
Thanksgiving
Chapter 13
Chapter 14
Essay
presentations
Essay
presentations
Quiz 5 on
Chapter 11-12
Quiz 6 Review
Quiz 6
**In-class final exam check MyCSULB for date and time of final exam.
Focus discussion questions week by week:
1. Do Americans personally pay for health care? What percentage of the doctor’s bill or
hospital’s bill is out of pocket? Has the out of pocket portion of the total bill increased or
decreased in recent years? Is this a problem? What does it do to costs when somebody
else pays the bill?
2. What are the major problems of U.S. health care? According to Obama? According to
Laffer? According to Freidman?
3. Do other nations really do it better than U.S. as charged by Reid? What are the three key
ways that other nations use to finance and organize health care (hint: see text page 20)?
4. How well do these nations actually achieve universal access?
5. Is healthcare a right? Is healthcare a public or a private good? Does it matter?
6. Can government successfully provide health care to all citizens? How high should taxes
be raised to pay for this care? What is the deadweight loss to the economy from high
taxes?
7. What is moral hazard? Adverse selection? Information asymmetry?
8. What is included in “managed care?”
9. Why is there a nursing shortage? Why is there a doctor shortage? What happened to
create a shortage of primary care doctors? What do shortages mean for the price and
availability of health care?
10. Is high technology the primary reason health costs are out of control? Is all technology
created equal or is some technology more cost beneficial than others?
11. Why is a good primary care system the foundation of health care?
12. Are hospitals at the heart of health care problems of cost and quality? How much
competition do hospital face?
13. Which are more efficient and effective: specialty (“focused factory”) hospitals or
community general hospitals?
14. Is managed care the answer to cost control? What are its potential benefits?
15. Why are nursing homes often so poorly run?
16. Do AIDS patients deserve what they get?
17. Do you feel safe going into a hospital? Having surgery there?
9
18. Do you favor national health insurance?
19. Will the U.S. solve its access problems? How?
20. Why does acute medical care (body repair) and public health have so different in history
and culture?
21. How has the fear of bioterrorism transformed the image of pubic health?
10
STUDENT INFORMATION SHEET
HCA 202; Fall 2009
(TURN IN TO INSTRUCTOR)
Name___________________________________________________________
Name you prefer to use____________________________________________
Address_________________________________________________________
________________________________________________________________
Phone(s):________________________________________________________
Best time/place to reach you:_______________________________________
Fax:_________________________________________________________
E-mail address:__________________________________________________
Please describe briefly:
a.
Your educational background and work experience:
b.
Future educational and career plans:
c.
Your reasons for taking this course, what you hope to learn from it:
d.
Other HCA classes you are taking or have completed:
11