“Five Questions”:

? You will write responses to five (5) questions provided by the instructor, each response

approximately 350-500 words long.

? These questions will help you identify and evaluate:

• ?  theroleofthegoverningbodythatyouaretargetingwithyourproposal;
• ?  thetwoopposingpolicypositionsandtheirclaimsmakers(i.e.thosewhoaresupporting

  each position and their investment in that stance); and,

• ?  your integration of conceptual material from weekly readings and class discussions

  through midterm, including:

  • ?  types of moral perspectives;
  • ?  political alliances and relative political power of policy proposals;
  • ?  impact of social factors/social conditions on issue and proposed solutions;
  • ?  current and projected disparities in healthcare use and outcomes.

    It is expected that you will be building on these writings as you proceed through the term.

    list of the topic

     

    Sources must include course readings as well as research from peer-reviewed academic

    journals.

    Final write-up of the paper is due at 7 p.m. on Wednesday of Finals Week and emailed to the instructor.

    Choose one of the following for your policy analysis paper.

    1. Public Health and Rights to Privacy: Should medical providers be bound by Public Health policies? Recently, a nurse who was exposed to the Ebola virus refused quarantine rules imposed by the legislature and health department of New Jersey. What were the arguments on both sides? What roles did science, cultural values and norms, and political posturing play in policymaking? What other factors were involved? What are implications for other issues in which private and public health sectors must collaborate?
    2. Is unregulated economic growth good for our health? Scientists argue that diminishing biodiversity in our ecosystems world-wide, much of it due to unrestricted development and other human activity, will affect our health in the future. Are there ways we can grow an economy and maintain diversity in the environment?
    3. Health care digitization and other new technologies in your doctor’s office: Physicians and their staffs are facing increased pressures to digitize medical records, and recruit and maintain a remote client base through telemedicine practices, i.e., incorporate new technologies into their practices. Are these new practices changing the doctor-patient relationship? What do both doctors and patients think about the changes? And, what roles are medical industries, healthcare corporations, and governments playing in effecting certain changes?
    4. Making the rules regarding women’s contraceptive choices: One of most controversial (and litigated) provision of the PPACA is the obligation of employer plans to cover contraceptive services under prevention. Businesses that oppose coverage have challenged the law and won concessions. What are the origins of this debate, both in the construction of the law and in the history of women’s contraceptive choices in America? What implications does this have for women’s health care and for future policymaking? Should private businesses be able to block access to health care for women?
    5. What should government do in response to the problem of access to health care?: The Obama administration developed a health care policy that addressed the tens of millions of Americans who in 2010 were uninsured (and millions more who were underinsured). What provisions of the PPACA attempt to create a more inclusive system? What are the values and politics behind them? What are the arguments opposed? Did the PPACA go far enough, as others contend the U.S. should transition to a federally-funded “Medicare for Everybody” universal health insurance system?
    6. What role should medical professionals have in military anti-terrorism practices?: Since the exposure of abuse of detainees at Abu Gharib in Iraq in 2003, critics have questioned the role of psychiatrists in the justification of torture practices by military interrogators. Should physicians and psychiatrists provide information that helps determine how much and what kind of mistreatment could be delivered to detainees of the military during interrogations? Is there a point where a doctor’s obligation to “do no harm” is suspended during times of war?

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    7. Immigrants and health care laws: In 1994 Californians passed an initiative, subsequently ruled unconstitutional, that included a provision requiring medical personnel to refuse care to undocumented immigrants. More recently, the Obama administration has ruled that while young undocumented immigrants may be allowed to be “lawfully present” in the U.S. (for schooling or work), they would not be eligible for health benefits under the new health care law. What are the obligations of a society to those within its borders? Is health care different from other kinds of “benefits”? How have other countries addressed this issue?
    8. Are there limits to the uses of medical technology?: Should genetic screening be used in hiring and contracting by employers, insurers, and governments? Is genetic enhancement an acceptable use of technology? These and other questions can be explored in determining at what point the costs of technologies (in terms of harm to persons or communities) outweigh the benefits.
    9. Technology and doctor/patient interaction: How are new medical technologies changing the doctor- patient encounter, as well as doctors’ approaches to clinical care? Is the use (or overuse of testing) improving diagnostic accuracy, or is this more myth than fact? What evidence speaks to what the balance should be between subjective observation and laboratory data in a doctor’s deliberations? Does the new health care law have something to say about the use of technologies in patient care?
    10. Off-label marketing of drugs: A common practice by physicians, and heavily promoted by drug companies, off-label use of drugs was given a boost by an appeals court decision in New York supporting marketing of drugs for uses not approved by the FDA. What are the pros and cons of this decision for doctors and patients? What should be the responsibilities of drug manufacturers, and what would be an appropriate governmental policy on this issue?
    11. Should medical providers be allowed to deny medications on grounds of conscience?: First pharmacists, and then, with the new provisions in the 2010 health care law, hospitals are exercising moral or religious grounds to gain exception to the mandate to provide birth control medications. Should exceptions be allowed? How should religious claims be weighed against individual rights?
    12. Should state legislatures or U.S. Congress regulate fracking? We are immersed in a new era of oil booms in North Dakota, Pennsylvania, and, more recently, Central California. Water infused with “various chemicals” (unidentified, to date) is blasted deep underground – below farms, close to water tables, handled by workers. Are these chemicals and processes harming workers or the environment? What responsibility do these companies have, not only to the environment which they are changing, but to workers and residents who may be affected by their practices?
    13. What’s the future for employer-based health care coverage?: At one time, employers willingly offered health care benefits as they competed with each other for workers. With outsourcing in the global labor market, high health care costs in the U.S., and a troubled economy, employers have implemented strategies for reducing their costs. What are some pre-2010 business strategies and current trends, and how does the ACA address them?
    14. Drug shortages, high-priced generics, and American health: Drug shortages have

     

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    increased dramatically in the last decade, nearly tripling. In especially short supply is a generic version of an important cancer drug. What is the threat to public health? What’s wrong with the drug production and distribution system? What have Congress and the FDA done in response? How can private enterprise and government agencies address this problem?

    15. Health Care and the poor: Community health providers who treat the poor find they cycle in and out of care due to periods of homelessness, jail time, and other barriers, disrupting medical regimens. What are implications for individual health and public health? What provisions of the ACA can help address these issues?

    Proposing an Alternative Topic

    If you prefer to work on a topic not listed above, you must submit a proposal (typewritten, single-spaced, due no later than our first class meeting) addressing each of these points and arguing why your topic is relevant to health care policymaking as well as recent health care reforms:

    1. (1)  state your key policy question (examples provided above);
    2. (2)  state what level of governance is involved at which a policy decision should be made

       (local, state, federal; specific agency), and provide the rationale for why that governmental

       entity is critical for this issue;

    3. (3)  identify 2 key positions on this issue, including how each identifies the problem and what

       each proposes for a solution; for example, using a topic above, DTC advertising of pharmaceuticals is argued by some as improving patient choice and by others as inventing demand – what is each side identifying as a problem, and what do they suggest be done about it?

    4. (4)  outline sources of evidence each position puts forth in its claims; and,
    5. (5)  finally, looking at the topic areas for each week of this course, consider which you expect to

       be most relevant for your topic and why; for example, DTC advertising of prescription drugs is relevant to the study of the patient empowerment movement as well as the study of medical industries and the role of profit-making in health-related fields.