MEDICARE

While the topics of these papers will differ based on the readings and
the themes of each class, the overall goal is that you identify and develop one key issue for policy or management
in a four-page paper.  Perhaps the
audience is an Assistant Secretary or Commissioner.  Maybe the audience is a Member of Congress or
member of the State Legislature or the City Council.  Perhaps the audience is the chief executive
of a hospital or another health care organization.  Maybe the audience is the head of a
non-profit organization that is involved with delivering services.  Possibly, the audience is the board of a
foundation interested in funding new or expanded efforts to improve health and
health care.  Or maybe the audience are
the staff and leadership of an interest group or advocacy organization seeking
to change public policy.  Any of them
want from their staff well-written analyses of key issues that they (and their
organizations) need to monitor and take action on. 

                        Your task is
NOT to summarize the readings in the body of the assignment.  Instead, you should assume that your audience
has already read the readings.  And this
assignment is not a “book report,” in which you go through the
readings, one by one, just to demonstrate that you “did the
readings.” 

                        Instead,
your task for this assignment is to carefully examine the readings and then identify a key issue for health
policymakers or managers.  After
identifying your chosen issue from among the issues raised by the readings, the
task is to develop an analysis of that key issue.  At this point, go back to the readings, and
start asking questions that will be relevant for your analysis:  What are the important dimensions of the
issue?  Maybe this involves empirical
data on the problem or policy situation. 
Maybe this involves analysis of the factors that shape the situation or
the incentives that different actors have. 
Maybe it involves key issues of equity, or fairness, or efficiency, or
good outcomes. 

                        As you
identify the dimensions you want to focus on, go
back again to the readings
to find supporting information.  You do
not need to use all of the readings (including, of course, the supplemental
readings) for a given week — many of them will be about other, related topics,
and not your topic.  But you should
definitively use the readings that are relevant. 

                        Be
careful:  you should use the readings
with a view towards citing them as part of your own analysis, and not simply as
something that your summarize or quote extensively.  Importantly, the argument of your paper
should reflect your own ideas as informed by the readings.  Indeed, you may discover that the authors of
the readings disagree with each other, or that you yourself disagree with the
approach taken by the authors, or that you believe that you have a different
approach to propose.  As the course
develops, you may also discover that relevant concepts and readings are also to
be found during other weeks of the course, not just the week of your
assignment.  As part of your analysis,
you may certainly summarize, explain, and develop the arguments of the authors
you agree with, and develop criticisms of authors you disagree with.  But in either case, it should be part of an
overall analysis that develops your own ideas, rather than providing a
“book report” that simply describes the readings.   

                        After you’ve
presented and analyzed the key issue, what would you recommend?  Be specific, for your chosen audience, what
action should they take and why?  How
does this action address the issue/concerns that you’ve raised in your
analysis?

                        You are free
to choose any particular issue that you think important, with the only
constraint being that it should be an issue discussed in the readings for the
class session you’ve signed up for. 
(That is, if the session is about Medicaid, then the issue paper should
draw on the readings about Medicaid). 
The approach you take for analyzing it and any recommendations you make
are yours as well. 

                        You can
certainly use other sources for your analysis, assuming that you provide full
bibliographic information (see below).  But, But, But, in my experience,
your paper is likely to be significantly stronger if you use your time to
focus on the readings in this syllabus rather than WANDERING around the internet via Google searches.  I have put together the readings with the
view that this course will provide comprehensive background information, and
enough substantive detail to support your analysis in these individual
papers.  The important contribution you
make in your papers will concern the ideas that you propose, and the supporting
arguments and evidence that you pull together. 
The quality of your argument (and your writing) is much more important
than relying on randomly-chosen references grabbed ad hoc from the
internet.   

Basic Readings:

Thomas Bodenheimer and Kevin Grumbach. Understanding Health Policy:  A Clinical Approach.  (New York, NY:  McGraw-Hill (Lange), Sixth Edition, 2012).

Paul Starr. The
Social Transformation of American Medicine. 
(New York, NY: Basic Books, 1982).

Bodenheimer, Thomas, and Kevin Grumbach. 2012. Chapters
2 and 3, “Paying for Health Care” and “Access to Health
Care.” (focus on the Medicare sections) in Understanding Health Policy:  A
Clinical Approach.  (New York, NY:  McGraw-Hill (Lange), Sixth Edition, 2012).

Starr, Paul. 1982. Book II, Chapter 3-4, focus on pp.
334-78 (“The Liberal Years”), and focus on pp. 379-405
(“End of a Mandate”) in The
Social Transformation of American Medicine. 
(New York, NY: Basic Books, 1982)

* Cubanski, Juliette, et al, Tricia Neuman.  2015. “A Primer on Medicare: Key Facts
About the Medicare Program and the People it Covers,” Kaiser Family
Foundation, 20 March 2015.  Available at: 
http://kff.org/medicare/report/a-primer-on-medicare-key-facts-about-the-medicare-program-and-the-people-it-covers/

* U.S. Dept. of Health and Human Services, Centers for
Medicare and Medicaid Services, (Medicare.gov). 2017. “Medicare 2017 Costs
at a glance,” available at: 
https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

Frameworks and Issues:

* Moon, Marilyn. 2006. “The Beneficiary’s
Perspective,” “Medicare in the ‘Big Picture,’” and “Are
Private Plans the Answer for Medicare,” in Medicare:  A Policy Primer
(Urban Institute Press), Chapters 1, 2, and 5. 

Kaiser Family Foundation. 2010. “Out of Pocket
Medicare Spending,” Medicare
Chartbook, Section 7. 

Krumholz, Harlan M., et al. 2015. “Mortality,
Hospitalizations, and Expenditures for the Medicare Population Aged 65 Years or
Older, 1999-2013,” Journal of the American Medical Association
314(4):355-65.

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