New York University Robert F. Wagner Graduate School of Public Service HPAM-GP 2836 – Current Issues in Health Policy Fall, 2013 - Version 1.2 Professor John Billings Room: Global Center for Academic and Spiritual Life (GCASL) 269 Course Description This course is an introduction to major health policy issues and examines the role of government in the health care system. An important focus of the course is an assessment of the role of policy analysis in the formation and implementation of national and local health policy. Because much of government health policy relates to or is implemented through payment systems, several sessions involve some discussion of the policy implications of how government pays for care, with a more detailed review of the economics of payment systems available in Health Economics: Principles (HPAM-GP4830). The role of the legal system with respect to adverse medical outcomes, economic rights, and individual rights is also discussed. Proposals for health policy reform at the national and local level are examined throughout the course, as well as Medicare and Medicaid reforms currently being implemented or considered. In an effort to accommodate a subset of students with scheduling challenges, this class will be held in four all-day Friday marathons on September 6th, September 20th, October 4th, and October 18th. There will be a morning and afternoon session on each of these days, with a lunch break between sessions and a brief break during the morning and afternoon sessions. This is a continuing experiment, and I have attempted to adapt the content of course to make these sessions less gruelling, but expect we may make some changes along the way. Course Requirements/Grading There are three papers required for the course, one accounting for 35% of the final grade, and the other two accounting for 25% each. See pages 11-13 below. Class discussion and debate are integral to the course and will account for 15% of the final grade. Papers can be submitted in my mailbox or using NYU Classes File Drop . There is no midterm or final exam. Students are expected to have studied the assigned readings. The readings for the course are primarily journal articles that will be posted in the Assigned Readings section of NYU Classes. There is no text book for the course (although some alternative texts are suggested in the readings for the AM Session of Day 1 for students with no prior health experience). The books required for the second paper are readily available at area bookstores or on the web (e.g., amazon.com, barnesandnoble.com, etc.). Copies of PowerPoint materials used in class will be posted in the Session Notes section on the NYU Classes site at least 24 hours in advance of the class. If you have questions about the reading materials or you need other help, please contact my administrative assistant, Craig Schott [295 Lafayette Street - 3rd Floor - 212-998-7477 – cs188@nyu.edu]. Office Hours By appointment (212-998-7455) - john.billings@nyu.edu - 295 Lafayette Street – 2nd Floor HPAM-GP 2836 Current Issues in Health Policy Day 1 –9/06/13 – AM Session Introduction – Description of course content, goals, and requirements Square One: The role of government in health/health care A discussion of the role of policy analysis in public policy formation and the impact of public policy on the health system Objectives of government in health and health care, discussion of limitations of government, and some examples Discussion of implications for policy Required reading: S. Schoenbaum S, A. Audet, and K. Davis, “Obtaining Greater Value from Health Care: The Roles of the U.S. Government,” Health Affairs (November/December 2003): 183190. G. Anderson, P Hussey, B Frogner, et al., “Health Spending in the United States and the Rest of the World,” Health Affairs (July/August, 2005): 903-914. Square Two: How health care is organized, financed, and paid for Brief overview of how health care is organized, where the money comes from, and how care is paid for A little bit about insurance and “managed” care Required reading: Kaiser Family Foundation: How Private Health Coverage Works: A Primer – 2008 Update. http://www.kff.org/insurance/7766.cfm S. Glied, “Health Insurance and Market Failure since Arrow”, Columbia University Suggested reading on how the health care delivery system is organized: T. Bodenheimer and K. Grumbach, Understanding Health Policy - Fifth Edition (New York: McGraw Hill, 2008) – Chapters 4-7. -- or -L.Shi, D. Singh, Delivering Health Care in America – (Jones & Bartlett Publishers, 2007) – Chapters 1, 7, 8, and 9 – Preview available at http://books.google.com -- or -A. Kovner, J. Knickman, Health Care Delivery in the United States – 10th Edition (New York: Springer Publishing Company, 2011) – Chapters 4-5. -2- HPAM-GP 2836 Current Issues in Health Policy Problems for discussion – Each student will be assigned to one of four “discussion groups” – these groups will be maintained throughout the semester and will be asked to address a specific problem or take on a roll for a specific issue. Assignments are posted in the Discussion Group section of Blackboard. For this session, each group will be asked to review one of the two problems outlined below. The discussion groups can meet during the lunch break and/or during the first 30 minutes of the Day 1 PM Session to discuss the issues related to the problem, and then each discussion group will report back to the full group. The problems are: Problem A – More than half of emergency department use is for non-emergent conditions or for conditions that could be treated safely and effectively in a primary care setting. Many emergency rooms suffer from serious overcrowding, often resulting in long waits for care or diversion of ambulances. What can government do promote/encourage/require more optimal emergency room use? Discussion Groups 1 and 2 Problem B – The Center for Medicare and Medicaid Services (CMS) requires hospitals to report results for patients for a set of “core performance measures” related to quality of care [such as percent of heart attack patients given aspirin at admission, fibrinolytic medication within 30 minutes, percutaneous coronary intervention (PCI) with 90 minutes, smoking cessation advice during the stay, beta blocker prescription at discharge, etc]. These process performance measures are reported publicly on the CMS website. Why does CMS believe it to be necessary to implement this reporting system for these very fundamental and widely accepted processes of care? What are the barriers to a hospital for actually improving results on these measures? Discussion Groups 3 and 4 Day 1 – 9/06/13 – PM Session Square 2 (continued): How health care is organized, financed, and paid for Finishing-up of how money changes hands Discussion of the implications for policy Quick look at English National Health Services (by way of comparison) and current proposals for reform Medical practice and health policy Review of the enormous variation in medical practice Discussion of causes of variation Discussion of the implications for policy -3- HPAM-GP 2836 Current Issues in Health Policy Required reading: E. Fisher, D. Wennberg, T. Stukel, et al., “The Implications of Regional Variation in Medicare Spending - Part 2: Health Outcomes and Satisfaction with Care,” Annals of Internal Medicine 138, No. 4 (2003): 288-299 J. Wennberg, E. Fisher, T. Stukel, et al., “Use of Hospitals, Physician Visits, and Hospice During the Last Six Months of Life among Cohorts Loyal to Highly Respected Hospitals in the United States,” British Medical Journal 328, No. 7440 (March 13, 2004): 607-610. K. Kozhimannil, M. Law, and B. Virnig, “Cesarean Delivery Rates Vary Tenfold Among US Hospitals; Reducing Variation May Address Quality and Cost Issues,” Health Affairs (March, 2013): 527-535 D. Eddy, “Evidence-Based Medicine: A Unified Approach,” Health Affairs (January/February, 2005): 9-17. D. Jones, “Visions of a Cure,” Isis (September 2000):91:504-541 – [http://www.jstor.org/browse/00211753/ap010310?frame=noframe&userID=807af334@ nyu.edu/01cc99333c3c2f10d557f64a8&dpi=3&config=jstor] A. Gawande, “The Cost Conundrum,” New Yorker, June 1, 2009 Day 2 –9/20/13 – AM Session Medicare: The basics and Issues for reform A discussion of the role and objectives of government in health Description of who and what is covered by Medicare Review of how Medicare pays for health care Description of the recent expansion Medicare to provide coverage for prescription drugs Issues for reform Required reading: C. Eibner, D. Goldman, J. Sullivan et al., “Three Large-Scale Changes to the Medicare Program Could Curb Its Costs but Also Reduce Enrollment,” Health Affairs (May, 2013): 891-899. K. Davis, C. Shoen, S. Guterman, “Medicare Essential: An Option to Promote Better Care and Curb Spending Growth,” Health Affairs (May, 2013)” 900-909. Henry J. Kaiser Family Foundation, Prescription Drug Coverage for Medicare Beneficiaries: A Summary of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (December 10, 2003) http://kff.org/medicaid/report/prescription-drug-coverage-for-medicare-beneficiaries-a-3/ Medicare and You: 2013 - http://www.medicare.gov/Pubs/pdf/10050.pdf -4- HPAM-GP 2836 Current Issues in Health Policy Issue for discussion groups - Should federal policy promote participation of Medicare recipients in private plans (managed care and/or fee for service)? If yes, why and how should such participation be promoted? Discussion groups will be assigned one of the following roles: Lefty – government can/should solve most of society’s problems types - Discussion Group 1 Republican right (whatever that might be) - Discussion Group 2 Health care providers - Discussion Group 3 Health insurance industry - Discussion Group 4 Medicaid: The basics History and financing of Medicaid Description of who and what is covered by Medicaid Required reading: S. Decker, “In 2011 Nearly One-Third of Physicians Said They Would Not Accept New Medicaid Patients but Rising Fees May Help,” Health Affairs (August, 2012) 1673-1679. B. Sommers, K. Baicker, and A. Epstein, Mortality and Access to Care among Adults after State Medicaid Expansions,” NEJM 2012;367:1025-34. Medicaid: A Primer 2013 - http://kff.org/medicaid/issue-brief/medicaid-a-primer/ Issue for discussion groups - It’s 1965 and Congress is designing a health coverage program for low income populations. What are your views on: i) who should be covered, ii) what should be covered, iii) federal/state/local roles, and iv) the role of private plans. Discussion group assignments: Lefty – government can/should solve most of society’s problems types - Discussion Group 2 Republican right (whatever that might be) - Discussion Group 3 Health care providers - Discussion Group 4 Health insurance industry - Discussion Group 1 Day 2 – 9/20/13 – PM Session Medicaid: Issues for reform What needs to be fixed/Issues for reform Responding to the needs of high cost/high risk patients -5- HPAM-GP 2836 Current Issues in Health Policy Required reading: D. Draper, R. Hurley, and A. Short, “Medicaid Managed Care: The Last Bastion of the HMO?” Health Affairs (March/April 2004): 155-167. J. Billings, T. Mijanovich, “Improving The Management of Care for High-Cost Medicaid Patients” Health Affairs no 6 (2007) 1643-1655. Problems for discussion in Day 2 PM Session Problem A – A large number of uninsured children and adults are eligible but not enrolled in Medicaid. Why? What can government/not-for-profit groups do to get more eligibles enrolled? What are the barriers? Who should do what? Discussion Groups 3 and 4 Problem B – It is possible to identify Medicaid patients from claims data who are at very high risk of future hospital admissions. These patients have high rates of chronic disease, mental health conditions, and substance abuse problems, and these patients are often homeless or precariously housed and socially isolated. What are the critical components of a program to respond the needs of these patients (reducing future hospital admissions), how can it be implemented (assuming there is no new money and the initiative would have to break even with savings from reduced hospital admissions covering the costs of the intervention), and what are the barriers to implementation? Discussion Groups 1 and 2 Day 3 – 10/04/13 – AM Session The major challenges confronting the health “system”: Disparities, Uninsurance, and Costs Overview of disparities in health services, utilization, and outcomes Discussion of the factors that are contributing to these disparities Description of the size and characteristics of the uninsured population Review of the causes of uninsurance Description of the dynamics of current cost increases Review of the causes and implications of cost increase Discussion of the implications of these challenges for policy makers and providers and for the current health reform initiative Required Reading: J. Billings, L. Zeitel, J. Lukomnik, et al., “Impact of Socioeconomic Status on Hospital Use in New York City” Health Affairs (Spring 1993): 162-173. -6- HPAM-GP 2836 Current Issues in Health Policy J. Billings, “Management Matters: Strengthening the Research Base to Help Improve Performance of Safety Net Providers,” Health Care Management Review 28, No 4 2003): 323-334. A. Jha, E, Orav, Low-Quality, High-Cost Hospitals, Mainly in the South, Care for Sharply Higher Shares of Elderly Black, Hispanic, and Medicaid Patients, Health Affairs (October 2011): 1904-1911. The Uninsured – A Primer - http://kff.org/medicaid/issue-brief/the-uninsured-a-primer/ U. Reinhart, P Hussey, and G. Anderson, “U.S. Health Care Spending in an International Context,” Health Affairs (May/June 2004): 10-25. H. Aaron and P. Ginsburg, “Is Health Spending Excessive? If So, What Can We Do About It?” Health Affairs (September/October 2009): 1260-1275. T. Phillipson, M. Eber, D. Lakdawalla, “An Analysis of Whether Higher Health Care Spending in the United States Versus Europe is “Worth It” in the Case of Cancer,” Health Affairs (April, 2012): 667-675. P. Cunningham, “The Growing Financial Burden of Health Care,” Health Affairs (May 2010): 1037-1044. U. E. Reinhardt, Is it Time for a More Rational All-Payer System? Health Affairs (November, 2011): 2125-2133. D. Cutler and N. Sahni, “If Slow Rate of Health Care Spending Growth Persists, Projections May Be Off by $700 Billion,” Health Affairs (May, 2013): 841-850. Z. Song, D. Safran, B. Landon et al., “The ‘Alternative Quality Contract,’ Based on a Global Budget, Lowered Medical Spending and Improved Quality” Health Affairs (August, 2012): 1885-1894. Problems for discussion in Day 3 PM Session Problem A – There are differences by race, ethnicity, and income in prevalence of diabetes, and these vulnerable populations have much higher rates of hospitalization for diabetic ketoacidosis/hyperosmolar syndrome and for amputations related to diabetes. You are advising a major local foundation that wants to create a program to help address this problem. Describe the range of initiatives the foundation should support – be specific about that activities supported and who the grants should go to. They’ve got about $10 million/year to spend on this program. Discussion Groups 2 and 4 Problem B – Escalating health costs remain a serious problem for the health care sector in the U.S., making health insurance less affordable and placing significant burdens on federal and state government budgets. What actions can be taken to help reduce the rate of increase in costs? What is the role of the federal government, state government, and private sector? Be specific and concrete about what actions can/should be taken and by whom. Discussion Groups 1 and 3 -7- HPAM-GP 2836 Current Issues in Health Policy Day 3 – 10/04/13 – PM Session Discussion group meetings and report back on recommendations Prior efforts to respond to these challenges: The role of the states, the Clinton Health Plan, and other federal initiatives Overview of policies/programs at the federal, state, and local level to reduce disparities, expand coverage, and control costs Discussion of the strengths and limits of state/local initiatives Discussion of the Clinton health plan, what problems it might have solved or created, and why it failed Implications for current reform initiatives Required Reading: W. Zelman, “The Rationale behind the Clinton Health Care Reform Plan,” Health Affairs (Spring 1994): 9-29. D. Yankelovich, “The Debate That Wasn’t: The Public and the Clinton Health Plan,” Health Affairs (Spring 1995): 7-23. R. Blendon, M. Brodie, and J. Benson, “What Happened to America’s Support for the Clinton Health Plan,” Health Affairs (Summer 1995): 7-23. J. Holahan, L. Blumberg, A. Weil, et al, “Roadmap to Coverage – Report for the Blue Cross Blue Shield of Massachusetts Foundation,” October, 2005 S. Long and K Stockey, “Sustaining Health Reform in a Recession: An Update on Massachusetts as of Fall 2009,” Health Affairs (June 2010): 1234-1241. G. Kenney, S. Long, and A. Luque, “Health Reform in Massachusetts Cut the Uninsurance Rate Among Children in Half,” Health Affairs (June 2010): 1242-1247. Kaiser Family Foundation, States Moving Towards Comprehensive Health Reform, July, 2009 - http://www.stateinnovation.org/Publications/All-Publications/Report---2008-11--Kaiser---State-Comprehensive-He.aspx National Health Reform 2010 Overview of Affordable Care Act (ACA) Discussion policy, politics, and power Required Reading: Kaiser Family Foundation: “Summary of the Affordable Care Act” – http://kaiserfamilyfoundation.files.wordpress.com/2011/04/8061-021.pdf -8- HPAM-GP 2836 Current Issues in Health Policy Kaiser Family Foundation: “Health Reform Implementation Timeline” – http://kff.org/interactive/implementation-timeline/ J. Morone, “Presidents and Health Reform: From Franklin D. Roosevelt to Barack Obama,” Health Affairs (June 2010): 1096-1100. J. Oberlander, “Long Time Coming: Why Health Reform Finally Passed,” Health Affairs (June 2010): 1112-1116. S. Shortell, L Casalino, and E. Fisher, “How CMS Innovation Should Test Accountable Care Organizations,” Health Affairs (July 2010): 1293-1298. C. Price and C. Eibner, “For States That Opt Out of Medicaid Expansion: 3.6 Million Fewer Insured and $8.4 Billion Less in Federal Payments,” Health Affairs (June, 2013): 1030-1036. Issue for discussion groups – At various points in the presentation on the health reform legislation that passed Congress in 2010, the perspectives of four interest groups on these points will be elicited. The four interest groups are: Lefty – reform didn’t go far enoughers – Discussion Group 3 Republican right (whatever that might be) – Discussion Group 4 Health care providers – Discussion Group 1 Employers – Discussion Group 2 Day 4 – 10/18/13 – AM Session More policy issues concerning the pharmaceutical industry Overview of the major policy issues concerning the pharmaceutical industry Discussion of the factors that are contributing to these emergence of these issues now Discussion of the role of government with respect to the pharmaceutical industry Required Reading: P. Stein and E Valery, “Competition: An Antidote to the High Price of Prescription Drugs,” Health Affairs (July/August 2004): 151-158. K. Kaphingst and W. DeJong, “The Educational Potential of Direct-to-Consumer Prescription Drug Advertising,” Health Affairs (July/August 2004): 143-150. J. Jeffords, “Direct-to-Consumer Drug Advertising: You Get What You Pay For,” Health Affairs - Web Exclusive (28 April 2004): W4 253-255. P. Kelly, “DTC Advertising’s Benefits Far Outweigh Its Imperfections,” Health Affairs Web Exclusive (28 April 2004): W4 246-248. -9- HPAM-GP 2836 Current Issues in Health Policy Optional reading: J. Weisman, D. Blumenthal, A Silk, et al., “Consumers’ Reports on the Health Effects of Direct-to-Consumer Drug Advertising,” Health Affairs - Web Exclusive (26 February 2003): W3 82-95. J. Weisman, D. Blumenthal, A Silk, et al., “Physicians Report on Patient Encounters Involving Direct-to-Consumer Drug Advertising,” Health Affairs - Web Exclusive (28 April 2004): W4 219-233. Medical errors – Medical malpractice Brief overview of current malpractice law Description of what is known about medical errors Analysis of the effectiveness of the legal system and malpractice law in assuring quality and compensating victims of harm Required reading: Institute of Medicine, “Report Brief - To Err is Human: Building a Safer Health System” - http://www.nap.edu/catalog/9728.html M. Mello, D. Studdert, and T. Brennan, “The New Medical Malpractice Crisis,” New England Journal of Medicine 343 No. 23 (2003): 2281-4. W. Sage, “Medical Liability and Patient Safety,” Health Affairs (July/August 2003): 2636. M. Hatlie and S. Sheridan, “The Medical Liability Crisis of 2003: Must We Squander the Chance to Put Patients First?” Health Affairs (July/August 2003): 37-40. A. Chandra, S. Nundy, S. Seabury, “The Growth of Physician Medical Malpractice Payments: Evidence from the National Practitioner Data Bank,” Health Affairs - Web Exclusive (31 May 2005): W5-240-249. C. Landrigan, G. Parry, C. Bones et al., “Temporal Trends in Rates of Patient Harm Resulting from Medical Care,” NEJM 2010;363:2124-34. Issue for discussion groups – In discussing malpractice reform (and efforts to reduce medical errors), each discussion group will be asked to make recommendations for government and/or private action from the perspective of one of the following interest groups: Lefty – government can/should solve most society’s problems types – Discussion Group 4 Republican right (whatever that might be) – Discussion Group 1 Health care providers – Discussion Group 2 Legal profession – Discussion Group 3 - 10 - HPAM-GP 2836 Current Issues in Health Policy Day 4 – 10/18/13 – PM Session Discussion group meetings and report back on recommendations Role of Patients – Making informed decisions Patient’s rights to refuse/withdraw treatment What information do patients need to make health care decisions (choice of treatment, doctor/hospital, health plan, etc.) What’s the best way to get information to patients Required reading: Cruzan v. Director, Missouri Department of Health – 497 U.S. 261 (1990) http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=us&vol=497&invol=261 M. Morgan, R Deber, H. Llewellyn-Thomas, “Randomized Controlled Trial of an Interactive Videodisc Decision Aid for Patients with Ischemic Heart Disease,” Journal of General Internal Medicine 15 No. 10 (2000): 685-693 A. O’Connor, H. Llewellyn-Thomas, and A. Flood, “Modifying Unwarranted Variations in Health Care: Shared Decision Making Using Patient Decision Aids,” Health Affairs – Web Exclusive (7 October 2004): VAR 63-72. D. Arterburn, R Wellman, E Westbrook, et al., “Introducing Decision Aids at Group Health Was Linked to Sharply Lower Hip and Knee Surgery Rates and Costs,” Health Affairs (September, 2012): 2094-2104. D. Veroff, A. Marr, and D. Wennberg, “Enhanced Support for Shared Decision Making Reduced Costs of Care for Patients with Preference Sensitive Conditions,” Health Affairs (February, 2013): 285-293. New York State Department of Health, Acute Cardiac Surgery in New York State: 20072009 (February, 2012): http://www.health.ny.gov/statistics/diseases/cardiovascular/heart_disease/docs/20082010_adult_cardiac_surgery.pdf - 11 - HPAM-GP 2836 Current Issues in Health Policy REQUIRED PAPERS Paper 0.5 – Personal Resume (Pass/Fail) – Provide a very brief resume/vita/something that describes who you are, employment experience (if any), and career goals (if any) and attach a recent photo of yourself (try Xeroxing you ID if you can’t do any better). Due Date: 9/13/13 – 11:59pm (use NYU Classes File Drop or put it in my mail box) Working in teams for Papers 1-3 – For Papers 1-3 you make work in teams of up to 3 students. However, teams must have members from at least two different “programs” (HPAM, PNMP, DNP, Bioethics, MPH, Executive MPA, Nursing Administration, etc). There is no requirement that you work on a team, and different teams can be formed for the various papers. Submit only one paper per team (and identify all team members). Paper 1 – The Dartmouth Atlas Memo (35% of final grade) – ≤ 8 pages – Take a look at the website for the Dartmouth Atlas of Healthcare. There is an interactive site, where you can pick out specific utilization or resource use measures for specific areas or hospitals (http://www.dartmouthatlas.org/) and there is also an area of the site where you can download Excel or pdf files with the data (http://www.dartmouthatlas.org/downloads.aspx) – this latter site much easier to navigate and I strongly recommend using it. Pick an example of variation in utilization (not costs or beds) that you believe is unwarranted and describe the range of factors that are likely to contribute to the differences among areas (or hospitals). Then pick one contributing factor that you think is important (or that you think something can be done about it) and make some suggestions about what might be done to reduce variation. Be specific and detailed in your suggestions, including who ought to do what to whom. Be realistic, don’t make suggestions that cannot be implemented because of technical, financial, or political considerations. This is a conceptual piece and not a research paper, but footnote sources of ideas from others that you use for the causes of variation (or the suggested solutions if the ideas come from a specific source). Due Date: Day 2 Session or submit via NYU Classes File Drop by 9/22/13 – 11:59PM Paper 2 – Book Memo (25% of final grade) - ≤ 6 pages – You are a newly hired policy staff person for some senator, the governor of any state, a health commissioner, the president of the National Association of Community Health Centers, CEO of a large health insurance plan/managed care plan, or some other health organization of your choice (domestic or international). Your boss walks by your cubicle and plops down one of the books listed below (or tickets to one of the films listed below) and asks you to read/see it and tell her/him i) what it’s about, ii) why it’s important, and iii) what it means to your organization/constituency. Select a book/film from the list below and write a brief memo (remembering your boss has a very short attention span and will stop reading if it goes beyond 6 pages). Make sure you identify your hypothetical employer. Adrian Nicole LeBlanc – Random Family: Love, Drugs, Trouble, and Coming of Age in the Bronx. - 12 - HPAM-GP 2836 Current Issues in Health Policy Anne Fadiman – The Sprit Catches You and You Fall Down. Sherwin Nulin – How We Die. Eric Klineberg – Heat Wave: A Social Autopsy of Disaster in Chicago; Going Solo: The Extraordinary Rise and Surprising Appeal of Living Alone Laurie Kaye Abraham – Mama Might Be Better Off Dead: The Failure of Health Care in Urban America. Jerry Avorn – Powerful Medicines : The Benefits, Risks, and Costs of Prescription Drugs. Andrew Solomon – The Noonday Demon. Richard Deyo and Donald Patrick – Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises. Shannon Brownlee - Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer Jerome Groopman – How Doctors Think John Abramson - Overdosed America : The Broken Promise of American Medicine Ray Moynihan/Alan Cassels – Selling Sickness Atul Gawande – Complications: A Surgeon’s Notes on an Imperfect Science or Better: A Surgeon’s Notes on Performance, or Better: A Surgeon's Notes on Performance, or The Checklist Manifesto: How to Get Things Right David Kessler – The End of Overeating: Taking Control of the Insatiable American Appetite John Wennberg – Tracking Medicine Otis Brawley – How We Do Harm: A Doctor Breaks Ranks Eric Manheimer - Twelve Patients: Life and Death at Bellevue Hospital Angela Coulter – Engaging Patients in Healthcare Film: Michael Haneke – Amour Film: Peter Nicks – The Waiting Room Due Date: Day 3 Session or submit via NYU Classes File Drop by 10/06/13 – 11:59PM Paper 3 – A Current Issue in Health Policy (25% of final grade) - ≤ 6 pages – Read the newspaper. All “semester”. Pick a news story from sometime during the “semester” and discuss how it relates to some topic covered in class. Give a brief summary of the article, and then discuss how it relates to, reinforces, amplifies, or contradicts something covered in class. If it is describing a problem in the health system, comment briefly on how the system is organized (not) and how we pay for things are likely to affect, contribute to, or impact the problem, and discuss what might be done about it (and how). If it is describing some amazing breakthrough, discuss whether it is really very likely to actually have any impact (and why), and again consider how the system is organized (not) and how we pay for things are likely to affect contribute to/impact the problem or breakthrough. Make it interesting (I have to read 40+ of these). Cite the date and source of the article. Due Date: Day 4 Session or submit via NYU Classes File Drop by 10/20/13 – 11:59PM - 13 -