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HEALTH from page 1 main challenge will be whether they should pass the mandate, which would require everyone to have health insurance, a passage that Dzau supports. Although Americans are still witnessing the “evolving” effects of the act, patients have certainly benefited since the ACA’s passage, said Short, who is also a senior research fellow with the Health Inequalities Program at the Sanford School of Public Policy. Short noted that the option for young adults to stay on their parents’ insurance plan until age 26 positively affects Duke students and the general population. Prior to the act, adults could only stay on their parents’ insurance until they were 18 or 21 if they were in school. As a result, adults ages 18 to 24 were
THE CHRONICLE
widely known to be the least insured population in the United States, a statistic that has changed since the Act’s legislation, she added. Patients also indirectly benefit from the increased funding provided for comparative effectiveness research, she said. “The Act has stimulated a sea of change from the ‘gold standard’ of all research being randomized control trials to increased interest in comparative effectiveness research,” Short said. “[This] asks not only if the treatment… works, but also if the treatment… works better than what is already out there.” The ACA was also successful in diminishing the ‘doughnut hole’—the period between coverage for prescription medication, said Dr. Robert Califf, vice chancellor for clinical and translational research and director of the Duke Translational Medicine Institute. Short noted her support for the Act and
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mandate, adding that organized nursing— which includes the American Nurses Association, American Academy of Nursing and American Association of Colleges of Nursing—supports the ACA in its entirety. Califf voiced his support for the act, but added that it is unknown if what is passed will be effectively implemented. “The way laws get written is that there is a law, but a lot of what actually happens is dependent on how the government organization actually operates the law,” he said. An ‘imperfect’ piece of legislation Although representatives from DUHS have shown overwhelming support for all aspects of the ACA, they admit there are aspects of the legislation that need work. The ACA is supposed to be coupled with reforms in order to bring down costs, Califf said, but these reforms are not guaranteed. It will also take a couple of years to see if the Act can be financially viable. “Everything has to kick in together for this to work. Otherwise, with increased coverage, everything stays the same and it just causes a big deficit,” Califf said. A classic quandary with health care is that Americans want both high quality and immediate health care without any tax increases, Short said, making it difficult to strike a balance. Still, she attributed the Act’s unclear financial model as a negative aspect of the legislation. Short added that the “extreme” partisan nature of Congress is what birthed imperfections in the Act and will prevent changes from being made. The main problem with the ACA is figuring out how to pay for it, Dzau said, but he believes providing insurance opportunities for everyone will be a good thing in the long run. “It’s not easy to implement, but if we don’t take this situation or opportunity,
we are not going to get what we want, which is better health care at an affordable cost,” he said. Medical ramifications The ruling will greatly impact the general population, Short said. Currently, insurers are unable to deny coverage to patients with preexisting conditions, a provision that would go away if the Supreme Court were to rule against the mandate. She added that if the Supreme Court were to rule against the entire act, several centers would be left unfunded, such as the Center for Medicare and Medicaid Innovation, and several states would not create health insurance exchanges. “The Act has already permanently changed the conversation about health care delivery and health care,” Short said. “Patients are just beginning to see some benefits.” Despite the Act’s patient focus, the ACA affects physicians as well, Califf said. The biggest change in medical care is that more private practices are beginning to disappear, either making long-term contracts with health systems or being employed by them, he said. Although this trend began before the ACA, this pattern of disappearing private practices has continued with its passage and could continue depending on the Supreme Court’s ruling. Califf said it is unclear as to whether this is a good or bad change. In a private practice, a physician has his or her own equity, meaning it is run like a small business. On one hand, this requires a doctor to be highly innovative to run the best practice, but on the other hand, a physician may be incentivized to do things—such as run unnecessary tests—to make money. “As an employee, you might be less incentivized to do things just to make money and… you have a better information system,” Califf said. “So there are the two sides of the coin.”
Open Courses in PUBLIC POLICY STUDIES Enroll now! There’s still space available!! Fall 2012 PUBPOL 165.01 Introduction to U.S. Health Care System TTH 8:30-9:45, Taylor Overview of the key health policy issues in the United States. Topics include: (1) sources of morbidity and mortality; (2) access to health care; (3) financing of health care including an overview of how health insurance works, Medicare and Medicaid and why there are uninsured persons and to what effect; (4) quality of health care; (5) the role of innovation in both treating disease and influencing costs; (6) mental health, including why drug and alcohol treatment is generally considered to be a mental health service; (7) the role of non-profit versus forprofit ownership of health care facilities and to what effect; (8) long term care; and (9) the impact of social phenomenon such as income inequality, social class and culture on health care. PUBPOL 290S.05 Journalism of Economic Crisis M 4:40-7:10, Bennett Explore how the news media has covered the economic crisis; read deeply and research, analyze and write about economic coverage. Examine the history of reporting about boom and bust. Questions explored about the news media and current coverage of the economy include: Did the news media miss the story of market bubbles leading up to the financial crisis? How well did leading news organizations understand and explain the nature of the crisis and the government’s responses? Was coverage affected by the simultaneous meltdown of some news organizations’ finances? What can we conclude about the performance of journalism in informing and educating the public, holding executives and officials accountable, representing the human story of struggle, hardship and inequality? PUBPOL 385S.01 Higher Education and News TH 4:40-7:10, Burness Analysis of content and methods of media coverage of major issues in higher education. Ways institutions try to shape (and respond to) media coverage. Includes a review of the history and distinctive characteristics of American higher education. Focus on a number of issues including finance, athletics, town-gown relations, academic freedom and political correctness, student culture, conflict of interest, rankings, scandals, globalization, and the impact of changing information technology PUBPOL 531S.01 Philanthropy: Power of Money TH 4:40-7:10, Skloot Seminar syle course designed to deepen understanding of philanthropy and its role in American society. Course will cover Philanthropy’s history, cultural origins, and influence on social policy. Students will learn how foundations work and issues they face to maintain legitimacy and efficacy. Not an introductory class. Permission required. Some experience in social sector required.
PUBPOL 590.01
Comparative Health Systems
TTH 1:25- 2:40, Taylor The interaction of historical, political, economic, cultural, legal/ethical, and sociological factors in the organization and operation of health care systems. Emphasis on how cultural values penetrate the social institutions (politics, economics) that determine health care policies and their reception by societal members. Effects of social and technological change on health care systems, comparing their effects across societies with differing histories, cultural values, and economic systems. Major focus on United States, England, Sweden, and other Western societies PUBPOL 590S.01
Social Determinants of Health
TH 3:05-5:35, Pearson This course provides an evidence-based multi-level, multi-dimensional analysis of public policy induced social determination of health. Over the course of the semester we will review, critically examine, synthesize and integrate historical, ideological, conceptual and theoretical arguments and empirical evidence to construct a comprehensive review of how social factors influence health and wellness. The express objective of this course is to have students become more critical consumers of the various sources of information which influence ideas and decision making that differentially promote or compromise health and wellness across diverse population groups in the US. Social factors we will consider include but are not limited to Socioeconomics, Gender, Race and Ethnicity, Cultural Influences, Social Integration and Cohesion, Immigration, Trans-nationalism, Discrimination, High Effort Coping, the Life Course Perspective, Place and Neighborhood, National Ideology, Philosophical Influences, Structural Inequality, Inter-sectionality, and the most promising policy sponsored initiatives that stand to enhance and improve health for all segments of the US population. PUBPOL 590S.02 What
Do Universities Do?
MW 1:25-2:40, Clotfelter Are universities the engine of economic growth, the mechanism for reproducing the ruling class, or just a summer camp with classes attached? Although we might think we know all about universities because we attend one or work at one, chances are our perspectives are limited or biased. This seminar explores what goes on in universities and what the consequences are for students and society. Topics include time use, industrial organization, the university as an organization, aims of higher education, branding, values, grade inflation, learning, technology of teaching, and sports.
PUBPOL 610S.01 Analysis for Strategic Design
and Regulation TTH 10:05-11:20, Hamoudi Applies tools from welfare economics, information economics, and mechanism design in order to analyze public policy problems in the context of asymmetric information and strategic behavior. Applications include: financial regulation, private and social insurance, corruption and accountability, provision of public goods, and others. Requires previous exposure to intermediate microeconomics (including basic game theory), and reasonable comfort with the mathematics of constrained optimization. PUBPOL 674.01
Media and Democracy
TTH 10:05-11:20, Mickiewicz This course examines the relationship between mass media and democracy mainly in the United States and as a part of American foreign policy making and implementation. It begins with a discussion of elections, in which the media, both “old” and “new” play an enormous role. We also discuss the way that both government and other institutions compete to set the issue agenda for the American public. “Framing” is central to the process by which certain interpretations of news events are targeted to different publics. Media and national security continue to display a constant tension and a history of revising the rules governing censorship and the press during military conflict. The economics of media have certainly gained center stage: the Internet and the cell phone; the “old” media and dying newspapers are all in the process of swift and profound change, while the public has become fragmented. PUBPOL 677S.01 Federal
Program Accountability
MW 3:05-4:20, Cohen Follows a federal spending or regulatory program from inception through implementation. Research of primary records, including state and local governments, and standard federal sources of primary documents, to compare performance with expectations. GIS and other visualization techniques to analyze program implementation. Website creation to detail program performance.