Health Policy Commons^™

The Effect Of Rhetoric On Progressive Health Care Reform Policies’ Public Perception, Megan Geher

Honors Theses

Health care is one of the most contentious issues in United States politics today, and there are a variety of reform plans on the table. In order for these reform plans to be politically feasible, it is fundamental that the rhetorical framing strategies utilized are done so with caution. In this paper, I seek to understand to what extent rhetorical framing plays a role in how Americans perceive progressive health care reform plans. While there are many factors that go into public support of policies, rhetoric is one factor that cannot be ignored, as it has shown to have significant …

Nonprofits And Government Agencies Addressing The Needs Of Mental Health Community, Wyatt Ulrich

School of Professional and Continuing Studies Nonprofit Studies Capstone Projects

Nonprofit organizations have been utilizing cross-sector collaboration to address problems that are not able to be solved on their own. A partner to make said collaboration can be with any organization, business, or volunteer who has the same goals as the nonprofit organization. Mental health nonprofit organizations specifically need more partners due to how little the world knows about mental health and mental illnesses. The government is one partner many mental health organizations aim to collaborate with. Government contracts have been known to help with the many challenges nonprofit organizations face like funding and services. Previous research has suggested this …

An Analysis Of Political And Legal Debates Concerning Medicaid Expansion In Virginia, Rick Mayes, Benjamin Paul

Political Science Faculty Publications

The Supreme Court’s historic June 2012 ruling regarding the Affordable Care Act (ACA) in National Federation of Independent Business v. Sebelius set the stage for a massive federalism battle over Medicaid expansion in the United States. The original language of the Act was intended to nationalize Medicaid by having every state expand their program’s eligibility to all individuals up to 138% of the federal poverty level. This would have significantly reshaped Medicaid, a joint federal-state health insurance program, into a universal entitlement for all low-income citizens. Currently, Medicaid eligibility varies dramatically from state to state. The Court held that the …

Strategies For Health Care Cost Containment (1980s-Present), Rick Mayes

Political Science Faculty Publications

The U.S. health care system during the past three decades has been over two interrelated questions: first, who will control the manner in which medical care is paid for, and, second, how much will it cost? Many health care experts believe that Medicare's efforts at cost control, primarily in the form of the program's seminal transition to and continual modification of prospective payment of health care providers, has both triggered and repeatedly intensified the economic restructuring of the U.S. health care system. Medicare is an almost $600 billion public health insurance program for individuals sixty-five years of age and older; …

Catholic Claims Stretch The First Amendment, Ellis M. West

Political Science Faculty Publications

The Obama administration recently issued a regulation requiring all employers except religious organizations to include contraceptives in their employees' health insurance. The Catholic Church and various politicians have accused the administration of violating the church's religious freedom. Although the administration has modified its original regulation, it continues to be attacked for "waging war" on religious freedom.

Beyond Capitation: How New Payment Experiments Seek To Find The 'Sweet Spot' In Amount Of Risk Providers And Payers Bear, Rick Mayes, Austin B. Frakt

Political Science Faculty Publications

A key issue in the decades-long struggle over US health care spending is how to distribute liability for expenses across all market participants, from insurers to providers. The rise and abandonment in the 1990s of capitation payments—lump-sum, per person payments to health care providers to provide all care for a specified individual or group—offers a stark example of how difficult it is for providers to assume meaningful financial responsibility for patient care. This article chronicles the expansion and decline of the capitation model in the 1990s. We offer lessons learned and assess the extent to which these lessons have been …

Postmortems On The Affordable Care Act (Book Review), Rick Mayes

Political Science Faculty Publications

Nearly two years after the Affordable Care Act became law, books are appearing by Washington insiders who detail how the legislation came about. The two reviewed here discuss and dissect topics related to the health reform law from decidedly different points of view.

Pay-For-Performance Reimbursement In Health Care: Chasing Cost Control And Increased Quality Through "New And Improved" Payment Incentives, Rick Mayes, Jessica Walradt

Political Science Faculty Publications

Pay-for-performance (P4P) reimbursement has become a popular and growing form of health care payment built on the belief that payment incentives strongly affect medical providers' behavior. By paying more to those providers who are deemed to deliver better care, the goal is to increase quality and, hopefully restrain cost growth. This article provides a brief explanation of: (1) how previous P4P plans in the U.S. have fared, along with their special relationship to primary care, and (2) how England's experience with P4P and newer versions of these kinds of plans being pursued in places such as Massachusetts might provide valuable …

The Way It Was In Health Policy, And Probably Will Be: Learning Lessons By Rashi Fein (Book Review), Rick Mayes

Political Science Faculty Publications

Learning Lessons by Rashi Fein is an enjoyable memoir from a scholar and policy adviser unlike any other. Fein’s influential involvement in health care policy dates back to John F. Kennedy’s administration, and his career as a leading health economist paralleled the significant growth in the political influence of health economists following the enactment of Medicare and Medicaid in 1965. Now an emeritus professor of the economics of medicine at Harvard Medical School, Fein writes here about the lessons he learned in medicine, economics, and public policy. His view of the policy process, as a way of coming to …

[Introduction To] Medicating Children: Adhd And Pediatric Mental Health, Rick Mayes, Catherine Bagwell, Jennifer L. Erkulwater

Bookshelf

Why and how did ADHD become the most commonly diagnosed mental disorder among children and adolescents, as well as one of the most controversial? Stimulant medication had been used to treat excessively hyperactive children since the 1950s. And the behaviors that today might lead to an ADHD diagnosis had been observed since the early 1930s as “organic drivenness,” and then by various other names throughout the decades.

The authors argue that a unique alignment of social and economic trends and incentives converged in the early 1990s with greater scientific knowledge to make ADHD the most prevalent pediatric mental disorder. New …

[Introduction To] Medicare Prospective Payment And The Shaping Of U.S. Health Care, Robert A. Berenson, Rick Mayes

Bookshelf

This is the definitive work on Medicare’s prospective payment system (PPS), which had its origins in the 1972 Social Security Amendments, was first applied to hospitals in 1983, and came to fruition with the Balanced Budget Act of 1997. Here, Rick Mayes and Robert A. Berenson, M.D., explain how Medicare’s innovative payment system triggered shifts in power away from the providers (hospitals and doctors) to the payers (government insurers and employers) and how providers have responded to encroachments on their professional and financial autonomy. They conclude with a discussion of the problems with the Medicare Modernization Act of 2003 and …

Medicating Children: The Enduring Controversy Over Adhd And Pediatric Stimulant Pharmacotherapy, Rick Mayes, Jennifer L. Erkulwater, Catherine Bagwell

Political Science Faculty Publications

Attention Deficit Hyperactivity Disorder (ADHD) holds the distinction of being both the most extensively studied pediatric mental disorder and one of the most controversial. This is partly due to the fact that it is also the most commonly diagnosed mental disorder among minors. On average, one in every ten to 15 children in the U.S. has been diagnosed with the disorder and one in every 20 to 25 uses a stimulant medication—often Ritalin, Adderall, or Concerta—as treatment. The biggest increase in youth diagnosed with ADHD and prescribed a stimulant drug occurred during the 1990s, when the prevalence of physician visits …

The Slave, The Fetus, The Body: Articulating Biopower And The Pregnant Woman, Kevin Kuswa, Paul Achter, Elizabeth Lauzon

Rhetoric and Communication Studies Faculty Publications

Many slaveholders attempted to justify the institution of slavery in the United States by claiming that the practice of slavery was actually in the interests of the slaves themselves. Not only are these arguments invalid because they justify inhumane treatment and the imprisonment of innocent human beings, they also contain a dangerous paternalism (a “speaking for”) that has not vacated the social sphere. Indeed, this same logic—the notion that bodies can be regulated and controlled for their own protection—is presently being used to speak for the fetus in order to justify fetal rights. Borrowing from Berlant (1997), these fetal rights …

Pursuing Cost Containment In A Pluralistic Payer Environment: From The Aftermath Of Clinton’S Failure At Health Care Reform To The Balanced Budget Act Of 1997, Rick Mayes, Robert E. Hurley

Political Science Faculty Publications

Following a decade in which Medicare operated as the leading ‘change agent’ within the US health care system, the private sector rose to the fore in the mid 1990s. The failure of President Clinton’s attempt at comprehensive, public sector-led reform left managed care as the solution for cost control. And for a period it worked, largely because managed care organizations were able to both squeeze payments to selective networks of medical providers and significantly reduce inpatient hospital stays. There was a lot of ‘fat’ in the nation’s convoluted health care system that could be (and was) eliminated through competitive negotiations …

The Origins Of And Economic Momentum Behind "Pay For Performance" Reimbursement, Rick Mayes

Political Science Faculty Publications

"Pay for performance," a reimbursement method under which some physicians and hospitals are paid more than others for the same services because they have been deemed to deliver better quality care and their patients appear to have better outcomes, is enormously controversial. Disputes invariably arise over how "quality" should (or even can) be measured. Nevertheless, differentiating between medical providers, financially, lies at the heart of this new reimbursement innovation developed by insurance companies and employers. Its two main objectives are: (1) to increase the overall quality of health care that patients receive, and (2) to encourage behavioral change on the …

Medicare And America's Healthcare System In Transition: From The Death Of Managed Care To The Medicare Modernization Act Of 2003 And Beyond, Rick Mayes

Political Science Faculty Publications

This article traces the transition-in Medicare, specifically, and in the American healthcare system, generally-from the aftermath of the Balanced Budget Act of 1997 to the passage of the Medicare Modernization Act of 2003. During this time, restrictive managed care died under an onslaught of resurgent cost pressures, legislative and legal attacks, and a vehement physician and consumer backlash. The subsequent reversion to more generous (and more expensive) health plans coincided with a recession in 2001 to trigger a return to rapidly escalating healthcare spending and yet another in the Nation's series of healthcare crises. Current trends suggest that future policymakers …

Universal Coverage And The American Health Care System Crisis (Again), Rick Mayes

Political Science Faculty Publications

Ten years after President Clinton’s ambitious attempt at comprehensive health care reform died, several old and new issues with the health care system have emerged. First, the number of uninsured Americans rose to 43.6 million in 2002—and the numbers have since increased. Also, the costs for those who do not have insurance are rapidly increasing. In addition health care related problems are one of the leading causes of personal bankruptcy in the United States. Finally, the government’s two primary health insurance programs—Medicare and Medicaid—are experiencing considerable financial strain. Dr. Mayes examines these problems in depth before and revisits President Clinton’s …

[Introduction To] Universal Coverage: The Elusive Quest For National Health Insurance, Rick Mayes

Bookshelf

Universal health coverage has become the Mount Everest of public policy in the United States: the most daunting challenge on the political landscape. But, despite numerous attempts, all efforts to achieve universal health care have failed. In Universal Coverage, Rick Mayes examines the peculiar and persistent lack of universal health coverage in America, its economic and political origins dating back to the 1930s, and the current consequences of this significant problem.

Did A Rising Tide Lift All Boats? The Nih Budget And Pediatric Research Portfolio, Daniel P. Gitterman, Robert S. Greenwood, Keith C. Kocis, Rick Mayes, Aaron N. Mckethan

Political Science Faculty Publications

This paper examines National Institutes of Health (NIH) pediatric research spending in absolute terms and relative to the doubling of the NIH overall budget between fiscal years 1998 and 2003. Pediatric spending increased by an average annual rate of 12.8 percent during the doubling period (almost on par with the NIH average annual growth rate of 14.7 percent). However, the proportion of the total NIH budget devoted to the pediatric portfolio declined from 12.3 to 11.3 percent. We offer recommendations for implementing existing commitments to strengthen the pediatric research portfolio and to protect the gains of the doubling period.

Enlisting New Soldiers In The War On Drugs, Porcher L. Taylor Iii

School of Professional and Continuing Studies Faculty Publications

To downsize the profits in illegal drug trafficking and thus strike an economic blow against the drug cartel, President Clinton should declare a week long moratorium on casual drug purchase and use The president recently expressed alarm that drug use among eighth-graders nationwide has increased 150 percent. Given that, this initiative should primarily focus on teenagers and college students.

Intimate Colonialism: The Imperial Production Of Reproduction In Uganda, 1907-1925, Carol Summers

History Faculty Publications

British concern over the reproduction of the population and society of Uganda intensified from 1907 through 1924. Institutions and ideologies were developed to cope with an epidemic of STDs, to promote the family as a unit of reproduction, and to reform motherhood. The British colonizers and the African elite of Uganda built a population crisis from a collection of beliefs and data. The perceived severity of this crisis - and the response it evoked - changed over the years. That response began as a straightforward medical attempt to treat the ill. After the World War, though, "social hygiene" became an …

[Introduction To] The Medical Offset Effect And Public Health Policy: Mental Health Industry In Transition, Jonathan B. Wight, John L. Fiedler

Bookshelf

Does the timely treatment of mental illness result in a drop in the cost of health care, and if so, what is the cost effectiveness? This study provides an overview, synthesis, and analysis of the medical offset effect. It demonstrates that a medical offset effect does exist and the size of the effect is significant. A behavioral model provides a precise method for ascertaining the dimensions of medical offset and an explanation of the underlying causal relationships. The offset effect for an important population group is analyzed through the use of Medicaid patient data from Georgia and Michigan. This clear, …