Requirements

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.

Books and other readings

Five books, clearly identified on the reading list, will be available for purchase at Labyrinth, though you will also be able to find them in Stokes. All other readings will also be available electronically.

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.

For the record

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

“Précis of Paul Starr’s The Social Transformation of American Medicine,” Journal of Health Politics, Policy and Law 29 (2004): 575-619.
Marc A. Rodwin, Conflicts of Interest and the Future of Medicine: The United States, France, and Japan (New York: Oxford University Press, 2011), Chs. 1, 5-7.
Lewis G. Sandy et al., “The Political Economy Of U.S. Primary Care,” Health Affairs, 28 (2009): 1136-1145.
Jill R. Horwitz, “Making Profits And Providing Care: Comparing Nonprofit, For-Profit, And Government Hospitals,” Health Affairs24 (2005):790-801.


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

Paul Starr, Remedy and Reaction: The Peculiar American Struggle over Health Care Reform (New Haven: Yale University Press, 2011), Introduction, Chs. 1-2.
Beatrix Hoffman, “Health Care Reform and Social Movements in the United States,” American Journal of Public Health 93 (2003), 75-85.
Sven Steinmo and Jon Watts, “It's the Institutions, Stupid! Why Comprehensive National Health Insurance Always Fails in America,” Journal of Health Politics, Policy and Law 20 (1995), 329-372.
David Blumenthal and James A. Morone, The Heart of Power: Health and Politics in the Oval Office (Berkeley: University of California Press, 2009), Conclusion; Eight Rules for the Heart of Power.

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

Starr, Remedy and Reaction, Chs. 3-7.
Jacob Hacker, “The Road to Somewhere,” Perspectives on Politics 8 (2010): 861-876.
Mollyann Brodie et al., “Liking the Pieces, Not the Package: Contradictions in Public Opinion during Health Reform.” Health Affairs29 (210): 1125-1130.

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

Regina Herzlinger, Who Killed Health Care? (New York: McGraw-Hill, 2007), 15-26, 157-92.
Timothy Stoltzfus Jost, Health Care at Risk: A Critique of the Consumer-Driven Movement (Durham, NC: Duke University Press, 2007), Chs. 2-3, 8-9.
James C. Robinson and Paul B. Ginsburg, “Consumer-Driven Health Care: Promise and Performance,” Health Affairs28 (January 27, 2009), w272-w281.
Deborah Stone, “Moral Hazard,” Journal of Health Politics, Policy and Law 36 (2011): 887-896.
Physicians for a National Health Program, “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance,” JAMA 290 (Aug 30, 2003).
William C. Hsiao, “State-Based, Single Payer Health Care—A Solution for the United States?” New England Journal of Medicine 364 (March 16, 2011), 1188-1190.

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

John McDonough, Inside National Health Reform (Berkeley: University of California Press, 2011), Chs. 5-6.
Starr, Remedy and Reaction, Chs. 8-9.
[an additional reading may be assigned]

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

Note: This is the day that the Supreme Court begins hearing arguments on the constitutionality of the Affordable Care Act.

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

Jonathan Oberlander, The Political Life of Medicare (Chicago: University of Chicago Press, 2003), 1-16.
Lisa Potetz et al., “Medicare Financing and Spending: A Primer,” (Kaiser Family Foundation, 2011).
House Committee on the Budget (Chairman Paul Ryan), The Path to Prosperity (2011).
Gail R. Wilensky, “Reforming Medicare – Toward a Modified Ryan Plan. New England Journal of Medicine 364 (2011): 1890-1892.
Daniel Gottlieb et al., “Prices Don’t Drive Regional Medicare Spending Variations,” Health Affairs29 (2010), 537–543.
Paul Starr, “The Medicare Bind,” American Prospect (November 2011), 24-35.


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

Elicia J. Herz, “Medicaid: A Primer,” Congressional Research Service, July 15, 2010.
Atul Gawande, “The Hot Spotters: Can We Lower Medical Costs by Giving the Neediest Better Care?” The New Yorker, January 24, 2011.
Elizabeth H. Bradley and Lauren Taylor, “To Fix Health Care, Help the Poor,” New York Times, December 9, 2011.
Eli Y. Adashi, H. Jack Geiger, and Michael D. Fine, “Health Care Reform and Primary Care--The Growing Importance of the Community Health Center,” New England Journal of Medicine362 (April 28, 2010), 2047–2050.


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

Victor R. Fuchs and Arnold Milstein, “The $640 Billion Question—Why Does Cost-Effective Care Diffuse So Slowly?” New England Journal of Medicine(May 26, 2011). 364:1985-1987.
Susan Bartlett Foote, “Why Medicare Cannot Promulgate a National Coverage Rule: A Case of Regula Mortis,” Journal of Health Politics, Policy and Law 27 (2002), 707-730.
Robert W. Dubois and Jennifer S. Graff, “Setting Priorities For Comparative Effectiveness Research: From Assessing Public Health Benefits To Being Open With The Public,” Health Affairs (December 2011),
David Blumenthal, “Wiring the Health System — Origins and Provisions of a New Federal Program [Part I],” New England Journal of Medicine365 (December 15, 2011):2323-2329, and “Implementation of the Federal Health Information Technology Initiative [Part II],” New England Journal of Medicine365 (December 22, 2011), 2426-2431.
David Kibbe and Brian Klepper, “Unfreezing the Health IT Market,” Health Affairs blog, January 12, 2011.
Frank Moss, “Our High-Tech Health Care Future,” New York Times, Nov. 11, 2011.


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)

McDonough, Inside National Health Reform, Ch. 8.
Joshua T. Cohen et al, “Does Preventive Care Save Money? Health Economics and the Presidential Candidates,” New England Journal of Medicine358 (February 14, 2008), 661-663.
Michelle Mello et al, “Obesity--the New Frontier of Public Health Law,” New England Journal of Medicine354 (June 15, 2006), 2601-2610.
Rosanna Mentzer Morrison et al., “Will Calorie Labeling in Restaurants Make a Difference?” Amber Waves (US Dept of Agriculture Economic Research Service, March 11, 2011).

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.