HCMI 4225: Health and Social Insurance
Spring 2019 9:30 AM – 10:45 PM Mon & Wed Room BUSN 203
Instructor: Shane Murphy; Email: shane@uconn.edu; Office: BUSN 460
Office Hours: Mon & Wed 11:00 AM – 12:30 PM and by appointment

This is the website for HCMI 4225: Health and Social Insurance. The syllabus can be found here.

On this page you can find a calendar which includes links to materials from each week and lists the weeks readings. Homework assignments are here.

Information about the midterm exam is here.

Information about the final exam is here.

Information about the final paper is here.

Course Schedule:

(for off campus access, you may need to use the UConn VPN)
January 23: Health landscape and costs (slides)
Readings:
*Fuchs, Victor R. “Major trends in the US health economy since 1950.” New England Journal of Medicine 366, no. 11 (2012): 973-977.
*Dieleman, Joseph L., et al. “US spending on personal health care and public health, 1996-2013.” Jama 316.24 (2016): 2627-2646. (optional)

January 28: Is health care a right (slides)
Readings:
*Bauchner, Howard. “Health care in the United States: a right or a privilege.” Jama 317, no. 1 (2017): 29-29.
*Lenchus, Joshua D. “The right to health care.” JAMA 317, no. 13 (2017): 1377-1378.
*Hamel, Mary Beth, Jennifer Prah Ruger, Theodore W. Ruger, and George J. Annas. “The elusive right to health care under US Law.” N Engl J Med 372, no. 26 (2015): 2558-63. (optional)
*Gawande, Atul. “Is health care a right?” New Yorker, October 2, 2017 (optional)

January 30: Health care as a public good (slides)
Readings:
*Karsten, Siegfried G. “Health care: private good vs. public good.” American Journal of Economics and Sociology 54, no. 2 (1995): 129-144.
*Galea, Sandro. “Public health as a public good.” Boston University School of Public Health, January 10, 2016, https://www.bu.edu/sph/2016/01/10/public-health-as-a-public-good/ (optional)

February 4: Economics of Health Insurance (slides)
Readings:
*Klein, Robert. (2014). A Primer on The Economics of Insurance.

February 6: Economics of Health Insurance (slides)
Readings:
*Klein, Robert. (2014). A Primer on The Economics of Insurance.

February 11: Economics of Health Insurance (slides)
Readings:
Nyman, John A. “Is ‘moral hazard’ inefficient? The policy implications of a new theory.” Health Affairs 23, no. 5 (2004): 194-199.
Cutler, David M., and Richard J. Zeckhauser. “Adverse selection in health insurance.” In Forum for Health Economics & Policy, vol. 1, no. 1. De Gruyter, 1998. (optional)

February 13: History of Insurance: Social Insurance (slides)
Readings:
*Wilbur J.. Cohen, and Milton Friedman. Social Security: Universal or Selective?. American enterprise institute for public research, 1972.
on youtube or in print
*Also read the Wikipedia pages on Cohen and Friedman
*Cutler, David M., and Richard Johnson. “The birth and growth of the social insurance state: Explaining old age and medical insurance across countries.” Public Choice 120, no. 1-2 (2004): 87-121.
*Hu, Aiqun, and Patrick Manning. “The global social insurance movement since the 1880s.” Journal of Global History 5, no. 1 (2010): 125-148.

February 18: History of Insurance: Social Security (slides)
Readings:
*Wilbur J.. Cohen, and Milton Friedman. Social Security: Universal or Selective?. American enterprise institute for public research, 1972.
on youtube or in print
*Also read the Wikipedia pages on Cohen and Friedman
*Cutler, David M., and Richard Johnson. “The birth and growth of the social insurance state: Explaining old age and medical insurance across countries.” Public Choice 120, no. 1-2 (2004): 87-121.
*DeWitt, Larry. “Research Note #25: Ponzi Schemes vs. Social Security.” Historians Office, Social Security Administration.

February 20: Social Security (slides)
Readings:
*Wilbur J.. Cohen, and Milton Friedman. Social Security: Universal or Selective?. American enterprise institute for public research, 1972.
on youtube or in print
*Also read the Wikipedia pages on Cohen and Friedman
*DeWitt, Larry. “Research Note #25: Ponzi Schemes vs. Social Security.” Historians Office, Social Security Administration.

February 25: History of Public Insurance legislation (slides)
Readings:
*Quadagno, Jill. “Why the United States has no national health insurance: Stakeholder mobilization against the welfare state, 1945-1996.” Journal of Health and Social Behavior (2004): 25-44.
*Blendon, Robert J., and John M. Benson. “Americans’ views on health policy: a fifty-year historical perspective.” Health Affairs 20, no. 2 (2001): 33-46.

March 3: Snow Day
*Youtube video: The RAND Health Insurance Experiment: A Retrospective at 40 Years
*Youtube video: Randomized evaluations & the power of evidence | Amy Finkelstein | TEDxPennsylvaniaAvenue
*Conover, Chris.Does The Oregon Health Study Show That People Are Better Off With Only Catastrophic Coverage? Forbes.com, May 7, 2013 (optional)
*Drum, Keven. What We Know—And What We Don’t—About the Oregon Medicaid Study, Mother Jones, May 6, 2013 (optional)

March 3: Title X (slides)
*Rosoff, Jeannie I., and Asta M. Kenney. "Title X and Its Critics." Family planning perspectives 16, no. 3 (1984): 111-119.
*Vamos, Cheryl A., Ellen M. Daley, Kay M. Perrin, Charles S. Mahan, and Eric R. Buhi. "Approaching 4 decades of legislation in the national family planning program: an analysis of Title X's history from 1970 to 2008." American journal of public health 101, no. 11 (2011): 2027-2037.
*Bailey, Martha J. "Reexamining the impact of family planning programs on US fertility: evidence from the War on Poverty and the early years of Title X." American Economic Journal: Applied Economics 4, no. 2 (2012): 62-97.

March 25: History of Private Health Insurance and Health Reform Proposals of the 1990s and 2000s (slides)
Readings:
*CSPAN: Harry and Louise Ads, 1993
*Amadeo, Kimberly. Hillarycare, the Health Security Act of 1993 The Balance, March 13, 2019
*Mertens, Maggie. Chart: Comparing Health Reform Bills: Democrats and Republicans 2009, Republicans 1993. Kaiser Health News, February 24, 2010

March 27: The Affordable Care Act (slides)
*Obama, Barack. “United States health care reform: progress to date and next steps.” Jama 316, no. 5 (2016): 525-532.
*“Summary of the Affordable Care Act.” KFF, April 23, 2013: http://files.kff.org/attachment/fact-sheet-summary-of-the-affordable-care-act

April 1: The Affordable Care Act (slides)
*Obama, Barack. “United States health care reform: progress to date and next steps.” Jama 316, no. 5 (2016): 525-532.
*“Summary of the Affordable Care Act.” KFF, April 23, 2013: http://files.kff.org/attachment/fact-sheet-summary-of-the-affordable-care-act
*Biskupic, Joan. “The inside story of how John Roberts negotiated to save Obamacare”. cnn.com, March 25, 2019

April 3: Effects of the Affordable Care Act (slides)
Readings:
*Obama, Barack. “United States health care reform: progress to date and next steps.” Jama 316, no. 5 (2016): 525-532.
*Courtemanche, Charles, James Marton, Benjamin Ukert, Aaron Yelowitz, and Daniela Zapata. “Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self‐Assessed Health.” Southern Economic Journal 84, no. 3 (2018): 660-691.
*Antonisse, Larisa, Rachel Garfield, Robin Rudowitz, and Samantha Artiga. “The effects of Medicaid expansion under the ACA: Updated findings from a literature review.” (2017). KFF

April 8: Discussion day: Costs of Health Care in the US (slides)
Readings: Choose one or two available readings from day’s reading list at this link. If you choose a reading less than 6 pages in length, you must choose a second reading that is also less than 6 pages in length. If you choose a reading longer than 6 pages, you must not choose a second reading. Once you’ve chosen your reading, write your name under student 1 or student 2. If two other students have already chosen a reading, you must choose a different reading. There will be a homework assignment related to this reading. There will also be quiz credit for participating in the discussion on April 8.

April 10: Costs, Payments, and Quality (slides)
Readings:
* Mendelson, Aaron, Karli Kondo, Cheryl Damberg, Allison Low, Makalapua Motúapuaka, Michele Freeman, Maya O’neil, Rose Relevo, and Devan Kansagara. “The effects of pay-for-performance programs on health, health care use, and processes of care: a systematic review.” Annals of internal medicine 166, no. 5 (2017): 341-353.

April 15: Health Insurance Financials (slides)
Readings:
* Reinhardt, Uwe. “Where does the health insurance premium dollar go?.” Jama 317, no. 22 (2017): 2269-2270.
* America’s Health Insurance Plans (AHIP), Where does the health insurance premium dollar go? May 22, 2018
* Rosenthal, Elisabeth. “Those indecipherable medical bills? They’re one reason health care costs so much hospitals have learned to manipulate medical codes—Often resulting in mind-boggling bills.” New York Times Magazine (2017).

April 17: Topics: ACOs and CVS-Aetna merger (slides)
Readings:
* Kaufman, Brystana G., B. Steven Spivack, Sally C. Stearns, Paula H. Song, and Emily C. O’Brien. “Impact of accountable care organizations on utilization, care, and outcomes: a systematic review.” Medical Care Research and Review(2017): 1077558717745916.
* Zycher, Benjamin. “Benefits of CVS/Aetna merger far outweigh the costs” June 6, 2018, The Hill

April 22: Legal and Legislative challenges to the ACA (slides)
Readings: None

April 24: Reform (slides
Readings:
Democratic plans:
* RAND, National Health Spending Estimates Under Medicare for All, 18 pages
* RAND, What is Single-Payer Health Care? A Review of Definitions and Proposals in the U.S. 10 pages
* American Progress, Medicare Extra for All A Plan to Guarantee Universal Health Coverage in the United States, 22* pages (inflated page count due to formatting)
KFF, Compare Medicare-for-all and Public Plan Proposals KFF, 11 pages 115116
Criticism of Democratic plans:
* Heritage, Government Monopoly: Senator Sanders’ “Single-Payer” Health Care Prescription Heritage, 19 pages
* AEI, The unanswered questions of Medicare for All Economics, Health Care, Health Economics, 10 pages
Republican plans:
* Commonwealth Fund, Evaluating the CARE Act: Implications of a Proposal to Repeal and Replace the Affordable Care Act, 22 pages
* RAND, The Effects of the American Health Care Act on Health Insurance Coverage and Federal Spending in 2020 and 2026, 17 pages
* Heritage, A Plan to Repeal and Replace Obamacare, 11 pages
* CATO, 36. Health Insurance Regulation, 20 pages (inflated page count due to formatting)
* CATO. 4. Repealing Obamacare, 12 pages (inflated page count due to formatting)
* KFF, Compare Proposals to Replace The Affordable Care Act
Criticism of Republican plans:
* CBPP, Latest Republican ACA Repeal Plan Would Have Similar Harmful Impacts on Coverage and Health as All the Others, 8 pages
* American Progress. Graham-Cassidy 2.0 New ACA Repeal Plan Revives Threats to Americans’ Health Care, 10 pages (inflated page count due to formatting)
Compromise proposals:
* AEI, The health reforms the GOP should embrace (but probably won’t), 4 pages
* AEI, Cost-reducing health policies: A response to Chairman Alexander and the Senate Committee on Health, Education, Labor, and Pensions, 17 pages

April 29: Reform class discussion/debate (slides)
Please come to class having read at least one of the plans in bold above for the class discussion. Class discussion will be counted as a quiz.

May 1: Class wrap-up and final exam review