Notes6321

NOTES, Political Science 6321, Health Policy, Spring 2006

These are links to summary outlines of frameworks, concepts, perspectives and facts.
Outlines were presented and critiqued as part of the discussion on the dates indicated and, usually, again on the following session.
Abbreviations: HPF: Health Policy Framework; GPF: General Policy Framework; Web: Links to key web sites; Glossary: Glossary provided by AcademyHealth
Accountability: Exams may concern material covered in these notes (except those noted as FYI) and in the links provided here (except the portions of the links under the heading For further information). The exams will cover links on the HPF and GPF only when the same links are made in the notes below.

Date Notes on Topics Covered Illustrations

Jan 9
Mon
a. Ironic dilemmas of U.S. health market and policy (Syllabus:1/9)

b. Fragmentation of power in the U.S.: creates complexity and incrementalism
a. "Best health care in the world; our health care system is broken."
a. Four states covering transition problems of Medicaare Part D
b.Federalist 10 and 51; Purposes of government

Jan 11 Wed
a. Web sources
b. Flu Pandemic?
c. Correction: the Media Review due Jan. 18 need cover only the days 11-13, rather than 9-13.
d. Frameworks GPF & HPF a. AcademyHealth, as for Glossary
b. Web: HHS; CDC

Jan 13 Fri
a. Change in due dates: Wed 11 assignments now due Fri 13; Fri 13 assignments now due Wed 18
b. Utah Health Department
c. Data pages: information sources
   1. Eccles Library
   2. Web sites
b. My Health Care (Web)
c.2. Web sites
    CDC: "diseases & conditions"
    National Institues of Health (NIH)
          "health information"
       Nation Library of Medicine
          PubMed

Jan 18 Wed
a. Mesaures of access go beyond "uninsured" to questions of who and what are covered.
b. Measures of cost concerns include questions of quality of life outcomes, probabilities of outcomes, etc.
c. Multiple Processes that shape policy.
d. Agenda Setting as one of these processes.
a. Maryland/Walmart case

b. Type II diabetes series in the New York Times

c. "Jones Outline"

d. Type II diabetes series in the New York Times

Jan 20 Fri
a. Who (or what) is influential (relative power)?

a. Type II diabetes series in the New York Times

Jan 23 Mon
a. Present value calculations and benefit-cost analysis

a. Type II diabetes series in the New York Times
a. Water quality improvment

Jan 25 Wed a. Expected value and decision trees
b. Quantitative tools related to quality (and cost)
c. More re who or what is influential
a. Type II diabetes series in the New York Times
b. expected value, decision trees, epidemiology, and biostatistics
c. tobacco policy; water quality

Jan 27 Fri
a. Change in due date: Individual data page due Fri., Feb. 3, not Mon., Jan. 30
b. Errors in medicine: measuring errors, and using measures to reduce errors
c. FYI Libbey Chuy is alerts us to Asthma and Genomics Conference

b. IOM reports: To Error is Human and Crossing the Quality Chasm

Jan 30 Mon
a. Change in assignments: Individual data page now due Mon., Feb. 6; Cancel the assigned written review of the NYTimes Web, but monitor it for discussion..
b. Health care experiences.
c. Measures re Access, Cost, and Quality
d. Bioethics

b. dialogue (and trust?) = quality.
c. access, more than insurance; cost re proportional distributions and trends; quality in types and distribution of elements of health care
d. The principles approach concerned with autonomy, nonmaleficence, beneficence, and justice.

Feb 1 Wed
a. The big picture; how will major changes affect future health policy?

a. E.g. FRB Chair; Supreme Court; State of the Union; oil prices and profits

Feb 3
Fri
a. Rhetoric (communication: not "mere rhetoric", but the "the art of speaking or writing effectively") for public administration
b. a. Change in assignments:
1. Individual data page now due Fri., Feb. 10; see email sent Fri., Feb. 3.
2. Data Page Analysis now omitted.
a. Communication for administration, as contrasted, for example, with a trial court.

b. Syllabus schedule, description of assignments, and grading now corrected.

Feb 6 Mon
a. Agenda Setting again, with two links previously made (Jones Outline; and Who or What Is Influential, note Lindblom here) and one new link (Divisions of Power)
a. State of the Union address
a. A "conforming" bias of our institutions and divisions of power?
a. Change in House of Representative leadership

Feb 8 Wed
a. Agenda Setting again: opportunities and difficulties
b. Scanning the environment: going beyond the specific target e.g.health to broad perspective e.g.politics
c. "Rational" politics: "muddling"
d. Midterm
a. The Danish cartoons
b. Health reform and campaign financing
c. The "donut hole"
      total charges: $2,250-5,100
      out of pocket: $750-3,600
d. Last year's midterm

Feb 10 Fri
a. Health Care Quality Control

b. Measures of Access [a/m]
c. Measures of cost [c/m]
d. Measures of quality [q/m]
e. "Hypotheses" re quality [q/h]
a. Flexner Report; Hospital accreditation; Donabedian
b. Pp. 6,7,11,18, &19 of Kaiser
c. Growth in costs of drugs
d. Medicare data: outcome measures
e. Habits: surgical team training

Feb 13 Mon
a. Sovereignty in "the people" as a basis for "federal" division of power.
b. "muddling" again: multiple values (Ylvisaker; Stone) and types of rationality (Deising)
c. Jones outline again and its problems (risks) -- see bottom of page re Jones outline, and consider connection to "muddling"
a. Consider (James Wilson) Preamble, Constitution; Civil War.
b. "muddling" and democracy consistent with multiple fundamental values, not with absolute ideology
c. from budgeting, back to formulation in federal payments for hospitals (DRGs) and physicians (RBRVS): see Glossary

Feb 15 Wed
a. Review schedule: no class Friday, 17th nor Monday, 20th.
b. Review first three rows of Health Policy Framework for Midterm; raise questions on Wednesday, 22nd.
c. Review for midterm should include all the links included in these notes and those so far included in the health policy framework. Review should also include your own class notes
d. WSJournal articles: structure of the health care market is (necessarily) only a partial market. Market issues relate to hypotheses/presumptions

a. Wednesday, 22nd: review; Friday, 24th: midterm
b. Note link Feb. 8, to last year's midterm (material covered was not the same as it is this year)
c. Changes in market change power of providers, professionals, payers, and patients.
d. Secondary links "for further information" do not need to be reviewed. Note some secondary links to the a/m and q/m cells, health policy framework, do not say this and should be followed.

Feb 17 Fri
No Class

Feb 20
Mon
No Class

Feb
22
Wed
Review for midterm

Feb 24 Fri

Midterm

Feb 27 Mon
a. Legitimating Programs (Jones): legitimation requires legitimacy; success in legitimation builds legitimacy
b. U.S. employer-based health insurance, an accidental history?
c. Insurance market structure a primary cause of access problems [a/i]
a. Will port security affect Presidenial leadership re health policy?
b. Role of WWII, tax preference, Kennedy and Johnson landslide
c. Market rewards insurers able to avoid those needing health care

Mar 1 Wed
a. How we pay for health care makes a difference [a/d]
b. Alternative mixes of market and government [c/d]
c. Approaches to quality improvement [q/d]
a. Hospital emergency room as the safety net
b. From state licensing of providers to VA hospitals
c. Spend more for quality or improve quality to reduce costs?

Mar 3
Fri
a. Approaches to quality improvement: Role of patient a. lifestyle, selection of care givers, interaction with care givers

Mar 6 Mon
a. Differences in types of media: print, web, TV.
b. Specific health topics, or political environment
c. Types of politics: [a/p], [c/p], [q/p]
a. Extent of reporter control of agenda and content, types of interaction, breadth of coverage, ability to drill down
b. Katrina hospital, or Presidential approval rating
c. Wilson typology

Mar 8 Wed
a. A quiz: accidental history?
b. Scarce resources
c. Discussion of proposed solutions: (1) incremental, (2) revolutionary
a. To encourage using the links
b. Financial, admin., and political
c. Opportunity? Wilson again. Quality improvement for 1 & 2?

Mar 10 Fri
a. Book reports: exercise in telling and in listening; find a theme that connects or contrasts the two books
b. further discussion of solutions: not to attack but to understand and improve
a. Consider a "media reviews" question as a theme; do 1 review of the 2 books, not two reviews
b. Burns: learning in transactional & transformational leadership

Mar 13 -17
spring break

Mar 20 Mon
Policy making
a. The "garbage can" model
b. Skill Persistence, and Luck
c. Multiple activities
d. Multiple actors
e. Multiple politics
f. Multiple cultrues
Products of opportunity?
a. Kingdon
b. Fritschler
c. Jones, again
d. Gaus
e. Wilson, again
f. Elazar

Mar 22 Wed
Review of Mar 20 links, in terms of common prescriptions for health care reforms
See above links
To be continued Fri, Mar 22

Mar 24 Fri
Review of Mar 20 links
Jones again, considering the special points made re each activity

Mar 27 Mon
a.1. Quantitative tools/Access
a. 2. Quantitative tools/Cost
a. 3. Quantitative tools/Quality
b. 1. Proposal: Market forces c/h again
b. 2. Proposal: Rationing
b. 3. Proposal: state single payer system

b. 4. Proposal: single payer with patients selecting from competing physicians
a.1. Expected value
a.2. Financial statements

b. 1. Especially (FYI) T. Rice

b. 3. Economic competition does not reward health benefits (FYI: Paul Peterson: City Limits)
State health care costs compete, again, with education expenditures
b. 4. Limits of market forces c/h again

Mar 29 Wed
a. Review of quantitative tools
b. Trust: In quantitative analysis & politics a. Financial reports and the use of trends and ratios
b. q/tq again and Wildavsky again

Mar 31 Fri
a. Leadership, Burns: (1) Transactional; (2) Transformational
b. Avoiding group think: Irving L. Janis Groupthink, seek multiple perspectives
c. Three models of policy making: Allison
a. (1) Legacy Highway; Part D
(2) FDR's New Deal; Hitler
c. Cuban missile crisis; Lincoln's cabinet Goodwin, Team of Rivals
c. Cuban missile crisis; consider proposed health care reforms

Apr 3 Mon
a. Administrative law: Fritschler; Rohr
b. Politics of regulation
c. Complexity: incrementalism and trust
d. Interactive skills
a. Regulation of cigarette ads
b. Tobacco, Fritschler etc. again
c. Wildavsky: budgeting
d. a/ti, c/ti, and q/ti

Apr 5 Wed
a. Wildavsky, Lindblom, Allison, and Jones, all again
b. Interactive tools a/ti, c/ti, and q/ti, again
c. Rhetoric and democracy a. Complexity, trust, & policy, as in budgeting and program design
b. Tools of government
Rhetoric and IOM studies, again
c. Washington, D.C. monuments

Apr 7 Fri.
a. "Reform"
Good Job! (i. e. the analysis by class)
a. Massachusetts plan: focus upon access; how relates to cost and quality?

Apr 10 Mon
a. Book discussion
b. The final exam will include questions re the books
a. Complications; Civil Action

Apr 12 Wed
a. Book discussion
a. Civil Action

Apr 14 Fri
a. Book discussion
a. Smoking & Politics

Apr 17 Mon
a. Book discussion

b. final exam
a. Spirit Catches;
Quality Chasm
b. Last year's final

Date	Notes on Topics Covered	Illustrations
Jan 9 Mon	a. Ironic dilemmas of U.S. health market and policy (Syllabus:1/9) b. Fragmentation of power in the U.S.: creates complexity and incrementalism	a. "Best health care in the world; our health care system is broken." a. Four states covering transition problems of Medicaare Part D b.Federalist 10 and 51; Purposes of government
Jan 11 Wed	a. Web sources b. Flu Pandemic? c. Correction: the Media Review due Jan. 18 need cover only the days 11-13, rather than 9-13. d. Frameworks GPF & HPF	a. AcademyHealth, as for Glossary b. Web: HHS; CDC
Jan 13 Fri	a. Change in due dates: Wed 11 assignments now due Fri 13; Fri 13 assignments now due Wed 18 b. Utah Health Department c. Data pages: information sources 1. Eccles Library 2. Web sites	b. My Health Care (Web) c.2. Web sites CDC: "diseases & conditions" National Institues of Health (NIH) "health information" Nation Library of Medicine PubMed
Jan 18 Wed	a. Mesaures of access go beyond "uninsured" to questions of who and what are covered. b. Measures of cost concerns include questions of quality of life outcomes, probabilities of outcomes, etc. c. Multiple Processes that shape policy. d. Agenda Setting as one of these processes.	a. Maryland/Walmart case b. Type II diabetes series in the New York Times c. "Jones Outline" d. Type II diabetes series in the New York Times
Jan 20 Fri	a. Who (or what) is influential (relative power)?	a. Type II diabetes series in the New York Times
Jan 23 Mon	a. Present value calculations and benefit-cost analysis	a. Type II diabetes series in the New York Times a. Water quality improvment
Jan 25 Wed	a. Expected value and decision trees b. Quantitative tools related to quality (and cost) c. More re who or what is influential	a. Type II diabetes series in the New York Times b. expected value, decision trees, epidemiology, and biostatistics c. tobacco policy; water quality
Jan 27 Fri	a. Change in due date: Individual data page due Fri., Feb. 3, not Mon., Jan. 30 b. Errors in medicine: measuring errors, and using measures to reduce errors c. FYI Libbey Chuy is alerts us to Asthma and Genomics Conference	b. IOM reports: To Error is Human and Crossing the Quality Chasm
Jan 30 Mon	a. Change in assignments: Individual data page now due Mon., Feb. 6; Cancel the assigned written review of the NYTimes Web, but monitor it for discussion.. b. Health care experiences. c. Measures re Access, Cost, and Quality d. Bioethics	b. dialogue (and trust?) = quality. c. access, more than insurance; cost re proportional distributions and trends; quality in types and distribution of elements of health care d. The principles approach concerned with autonomy, nonmaleficence, beneficence, and justice.
Feb 1 Wed	a. The big picture; how will major changes affect future health policy?	a. E.g. FRB Chair; Supreme Court; State of the Union; oil prices and profits
Feb 3 Fri	a. Rhetoric (communication: not "mere rhetoric", but the "the art of speaking or writing effectively") for public administration b. a. Change in assignments: 1. Individual data page now due Fri., Feb. 10; see email sent Fri., Feb. 3. 2. Data Page Analysis now omitted.	a. Communication for administration, as contrasted, for example, with a trial court. b. Syllabus schedule, description of assignments, and grading now corrected.
Feb 6 Mon	a. Agenda Setting again, with two links previously made (Jones Outline; and Who or What Is Influential, note Lindblom here) and one new link (Divisions of Power)	a. State of the Union address a. A "conforming" bias of our institutions and divisions of power? a. Change in House of Representative leadership
Feb 8 Wed	a. Agenda Setting again: opportunities and difficulties b. Scanning the environment: going beyond the specific target e.g.health to broad perspective e.g.politics c. "Rational" politics: "muddling" d. Midterm	a. The Danish cartoons b. Health reform and campaign financing c. The "donut hole" total charges: $2,250-5,100 out of pocket: $750-3,600 d. Last year's midterm
Feb 10 Fri	a. Health Care Quality Control b. Measures of Access [a/m] c. Measures of cost [c/m] d. Measures of quality [q/m] e. "Hypotheses" re quality [q/h]	a. Flexner Report; Hospital accreditation; Donabedian b. Pp. 6,7,11,18, &19 of Kaiser c. Growth in costs of drugs d. Medicare data: outcome measures e. Habits: surgical team training
Feb 13 Mon	a. Sovereignty in "the people" as a basis for "federal" division of power. b. "muddling" again: multiple values (Ylvisaker; Stone) and types of rationality (Deising) c. Jones outline again and its problems (risks) -- see bottom of page re Jones outline, and consider connection to "muddling"	a. Consider (James Wilson) Preamble, Constitution; Civil War. b. "muddling" and democracy consistent with multiple fundamental values, not with absolute ideology c. from budgeting, back to formulation in federal payments for hospitals (DRGs) and physicians (RBRVS): see Glossary
Feb 15 Wed	a. Review schedule: no class Friday, 17th nor Monday, 20th. b. Review first three rows of Health Policy Framework for Midterm; raise questions on Wednesday, 22nd. c. Review for midterm should include all the links included in these notes and those so far included in the health policy framework. Review should also include your own class notes d. WSJournal articles: structure of the health care market is (necessarily) only a partial market. Market issues relate to hypotheses/presumptions	a. Wednesday, 22nd: review; Friday, 24th: midterm b. Note link Feb. 8, to last year's midterm (material covered was not the same as it is this year) c. Changes in market change power of providers, professionals, payers, and patients. d. Secondary links "for further information" do not need to be reviewed. Note some secondary links to the a/m and q/m cells, health policy framework, do not say this and should be followed.
Feb 17 Fri	No Class
Feb 20 Mon	No Class
Feb 22 Wed	Review for midterm
Feb 24 Fri	Midterm
Feb 27 Mon	a. Legitimating Programs (Jones): legitimation requires legitimacy; success in legitimation builds legitimacy b. U.S. employer-based health insurance, an accidental history? c. Insurance market structure a primary cause of access problems [a/i]	a. Will port security affect Presidenial leadership re health policy? b. Role of WWII, tax preference, Kennedy and Johnson landslide c. Market rewards insurers able to avoid those needing health care
Mar 1 Wed	a. How we pay for health care makes a difference [a/d] b. Alternative mixes of market and government [c/d] c. Approaches to quality improvement [q/d]	a. Hospital emergency room as the safety net b. From state licensing of providers to VA hospitals c. Spend more for quality or improve quality to reduce costs?
Mar 3 Fri	a. Approaches to quality improvement: Role of patient	a. lifestyle, selection of care givers, interaction with care givers
Mar 6 Mon	a. Differences in types of media: print, web, TV. b. Specific health topics, or political environment c. Types of politics: [a/p], [c/p], [q/p]	a. Extent of reporter control of agenda and content, types of interaction, breadth of coverage, ability to drill down b. Katrina hospital, or Presidential approval rating c. Wilson typology
Mar 8 Wed	a. A quiz: accidental history? b. Scarce resources c. Discussion of proposed solutions: (1) incremental, (2) revolutionary	a. To encourage using the links b. Financial, admin., and political c. Opportunity? Wilson again. Quality improvement for 1 & 2?
Mar 10 Fri	a. Book reports: exercise in telling and in listening; find a theme that connects or contrasts the two books b. further discussion of solutions: not to attack but to understand and improve	a. Consider a "media reviews" question as a theme; do 1 review of the 2 books, not two reviews b. Burns: learning in transactional & transformational leadership
Mar 13 -17	spring break
Mar 20 Mon	Policy making a. The "garbage can" model b. Skill Persistence, and Luck c. Multiple activities d. Multiple actors e. Multiple politics f. Multiple cultrues	Products of opportunity? a. Kingdon b. Fritschler c. Jones, again d. Gaus e. Wilson, again f. Elazar
Mar 22 Wed	Review of Mar 20 links, in terms of common prescriptions for health care reforms	See above links To be continued Fri, Mar 22
Mar 24 Fri	Review of Mar 20 links	Jones again, considering the special points made re each activity
Mar 27 Mon	a.1. Quantitative tools/Access a. 2. Quantitative tools/Cost a. 3. Quantitative tools/Quality b. 1. Proposal: Market forces c/h again b. 2. Proposal: Rationing b. 3. Proposal: state single payer system b. 4. Proposal: single payer with patients selecting from competing physicians	a.1. Expected value a.2. Financial statements b. 1. Especially (FYI) T. Rice b. 3. Economic competition does not reward health benefits (FYI: Paul Peterson: City Limits) State health care costs compete, again, with education expenditures b. 4. Limits of market forces c/h again
Mar 29 Wed	a. Review of quantitative tools b. Trust: In quantitative analysis & politics	a. Financial reports and the use of trends and ratios b. q/tq again and Wildavsky again
Mar 31 Fri	a. Leadership, Burns: (1) Transactional; (2) Transformational b. Avoiding group think: Irving L. Janis Groupthink, seek multiple perspectives c. Three models of policy making: Allison	a. (1) Legacy Highway; Part D (2) FDR's New Deal; Hitler c. Cuban missile crisis; Lincoln's cabinet Goodwin, Team of Rivals c. Cuban missile crisis; consider proposed health care reforms
Apr 3 Mon	a. Administrative law: Fritschler; Rohr b. Politics of regulation c. Complexity: incrementalism and trust d. Interactive skills	a. Regulation of cigarette ads b. Tobacco, Fritschler etc. again c. Wildavsky: budgeting d. a/ti, c/ti, and q/ti
Apr 5 Wed	a. Wildavsky, Lindblom, Allison, and Jones, all again b. Interactive tools a/ti, c/ti, and q/ti, again c. Rhetoric and democracy	a. Complexity, trust, & policy, as in budgeting and program design b. Tools of government Rhetoric and IOM studies, again c. Washington, D.C. monuments
Apr 7 Fri.	a. "Reform" Good Job! (i. e. the analysis by class)	a. Massachusetts plan: focus upon access; how relates to cost and quality?
Apr 10 Mon	a. Book discussion b. The final exam will include questions re the books	a. Complications; Civil Action
Apr 12 Wed	a. Book discussion	a. Civil Action
Apr 14 Fri	a. Book discussion	a. Smoking & Politics
Apr 17 Mon	a. Book discussion b. final exam	a. Spirit Catches; Quality Chasm b. Last year's final