Besides doing the readings and participating actively in the discussion, the requirements for the seminar are writing and presenting three short reports (4-5 pages, approximately 1200 words each) and one medium-length final paper (12-15 pages, or 3000-3500 words). There is also a small assignment for the first class.
Suggested topics for the short reports appear on the syllabus. The listed topics are not meant to be exhaustive; you can propose others. No later than the day after the first class, please email me a list of at least five topics, spread through the semester, that you'd be willing to report on. Depending on how widely distributed the preferences are, I may be able to give you your top choices, or I may ask you to write about an "orphan" subject that needs to be covered.
Reports should be e-mailed to me by 8 p.m. Sunday, the day before the seminar when the report is to be presented.
The final papers can deal with any contemporary health policy issue that grows out of the course. The core of the paper should be an analysis of a problem and possible alternative ways of dealing with it. An appendix--no more than two pages--should be prepared as if it were a concise decision memo for the president, a department secretary, or a governor. The memo may also be addressed to the CEO or board of a private institution.
I will be available to discuss possible subjects for the final paper during the first half of the semester. Please email me a paragraph about your proposed topic the week after spring break. Final papers are to be presented at the final class on April 30, though the written version is not due until one week later--by email, 5 p.m., May 7.
Grades will be based half on oral participation, half on written work.
When you see before a reading on the (online) syllabus, that means you can just click through to it (as long as you are logged on to the Princeton network, whether on or off campus). When you see before a reading, you can find it in e-Reserves. means the book is available for purchase at Labyrinth and on reserve at Stokes.
On a rotating basis, two students each week will be asked to take notes on the discussion, to merge them afterward, and then to post those notes on Blackboard as a record of our discussion. During class everyone else should put away laptops, tablet computers, cell phones, and other devices, though you are welcome to take notes the old-fashioned way--on paper.
February 6. Introduction – defining the problems, thinking through the goals
Deborah Stone, Policy Paradox , 2d or 3d ed. (New York: W.W. Norton, 2001 or 2011), Introduction, Parts I and II. Note: the third edition was just published in December, but assigned readings reflect the second edition. Either edition is fine for the class.
Donald M. Berwick, Thomas W. Nolan and John Whittington, “The Triple Aim: Care, Health, and Cost,” Health Affairs 27 (2008), 759-769.
Henry J. Aaron and Paul B. Ginsburg, “Is Health Spending Excessive? If So, What Can We Do About It?” Health Affairs28 (September-October 2009): 1260-75.
John Holahan and Vicki Chen, “Changes in Health Insurance Coverage in the Great Recession, 2007-2010 (Kaiser Family Foundation, December 2011).
Assignment for first class: pick two from among the goals discussed in Stone’s Policy Paradox—equity, efficiency, security, or liberty—and prepare a list of points for discussion on how the complexities Stone highlights apply (or don’t apply) to health care reform.
February 13. Institutional foundations: professions, organizations, and health care
Possible report topics: unassigned portions of Rodwin book on France or Japan; physician self-referral and health-care costs in the US; drug advertising and clinical decision-making; the implant scandal; policies for strengthening primary care; Wennberg's "shared decision-making" model.
February 20. The American path in health insurance
Possible report topics: tax exclusion of employer health insurance payments; veterans’ hospital system; the promotion of HMOs as a public policy; the turn toward prospective payment in Medicare; federalism and American health policy.
February 27. Politics of health policy, Clinton to Obama
Possible report topics: role of the CBO and the budget process; interest groups and health reform; relation of presidents and Congress in reform; evolution of party politics and health reform; role of the media.
March 5. Health policy, right and left
Possible report topics: development of Republican policy proposals; history of single-payer proposals; use of foreign models in American policy debates.
March 12. Evaluating the Affordable Care Act
Possible report topics: adequacy of subsidies in ACA; variation among states in scale and impact of Medicaid expansion; employer response to ACA; health care cost containment in ACA.
March 26. Choice architecture in health care: Insurance market reforms and design of health insurance exchanges
Richard H. Thaler and Cass R. Sunstein, Nudge: Improving Decisions about Health, Wealth, and Happiness, expanded edition (New York: Penguin, 2009), Introduction, Chs. 1-5, 10-11. (pp. 1-102 161-184).
Jon Kingsdale and John Bertko, “Insurance Exchanges under Health Reform: Six Design Issues for the States,” Health Affairs, 29 (2010): 1158-1163.
Fredric Blavin et al., "State Progress Toward Health Reform Implementation: Slower Moving states Have Much to Gain" (Urban Institute/Robert Wood Johnson Foundation, January 2012).
Possible report topics: constitutionality of the individual mandate; constitutionality of the Medicaid expansion; implementation of the mandate; ownership and control of health insurance exchanges; regional exchanges; adverse selection into insurance exchanges; risk adjustment; exchanges as clearinghouses versus active purchasers.
April 2. Medicare policy and seniors
Possible report topics: policies to deal with regional variations in Medicare spending; merging Medicare Parts A and B; means-testing Medicare; raising Medicare eligibility age; payments for medical education.
April 9. Vulnerable populations/community organizing
Possible report topics: dual eligibles; the disabled; immigrants; barriers to access in low-income and minority neighborhoods; socioeconomic health disparities and health reform.
April 16. Comparative effectiveness, coverage, and health information technology
Possible report topics: case studies in coverage decisions (e.g., vertebroplasty); prostate cancer screening; mammography; the politics of comparative effectiveness research; privacy and health information technology,
April 23. Public health and prevention/scenarios for the future (second half discussion)
Possible report topics: the prospective impact of the ACA’s public health fund; lessons of anti-tobacco policy; wellness incentives and health insurance; taxes (e.g., on cigarettes or soda) as a public health measure.
April 30. Final paper presentations.