Repeal and replace. Medicaid expansion. Medicare for all. Essential benefits. Pre-existing conditions. Private versus government-funded insurance.
If ever there was a course to be taught in real time, University of Virginia nursing professor Rick Mayes’ graduate course, “Intro to the U.S. Health Care System,” is it.
First developed and taught in fall 2014 as a primer for mostly nursing and medical students, Mayes – Talbott Visiting Professor at the School of Nursing this fall and a former White House health policy adviser – today acknowledges health care’s rapidly changing landscape makes a fixed syllabus impossible and news-tracking imperative.
So while he relies on his own reservoir of knowledge to provide historic background and context, a bevy of news sites (The Wall Street Journal, New York Times, Washington Post and VOX, along with professional journals like Health Affairs and the Journal of the American Medical Association) provides the spice that flavors course content and drives classroom discussions.
With the contentious passage of the Affordable Care Act, also known as Obamacare; the U.S. Supreme Court’s 2012 declaration of its constitutionality; Medicaid expansion; Healthcare.gov’s rocky start; 22 million Americans gaining health insurance coverage; dramatic premium jumps; and the arrival of President Trump (who terms Obamacare “a disaster”), there is much to cover.
Three years ago, Mayes had a dozen students sign up for his course. This fall? He had to cap it at 60.
“It’s such a prominent topic, maybe the most-discussed domestic topic of our time,” Mayes said. “There are so many students who are touched by health care, who see its effects, and because of that, the class has gotten more popular – and more personal.”
The heightened interest in the course comes as the Senate failed again this week in its effort to dismantle the Affordable Care Act.
Mayes said his nursing and medical students often share poignant stories about patients affected by insurance costs or a lack of coverage. He said the same holds true for many students from the Darden School of Business, the McIntire School of Commerce, the Curry School of Education, the Frank Batten School of Leadership and Public Policy and the Woodrow Wilson Department of Politics.
“The main thing is that students are more interested and more emotionally invested in the topic,” Mayes said, “whether it’s because they have parents or siblings with preexisting conditions, have benefitted from staying on their parents’ insurance for longer, had their income go down and qualified for Medicaid, or have had their income go up and then been outside the boundaries for subsidies on the insurance exchange.”
This fall, students are examining European health care systems, as well as some closer to home, like Pennsylvania’s Geisinger Health, Kaiser Permanente and Intermountain Healthcare, which is based in Utah. They’ll focus on the growing understanding of how primary care prevents catastrophic health events, distress and enormous medical costs down the line; will examine employee wellness programs; and peer at some new venture capitalist programs with for-profit health care firms for primary care. Mayes’ students will also hear from health care stakeholders across the spectrum, including device manufacturers, occupational and physical therapists and mental health professionals.
The first hour or so of Mayes’ class is devoted to lecturing on a topic, or deconstructing the reality behind the news. After that, Mayes said, there will often be a question, “which develops a chain reaction and then, well, I just pull up a chair and listen. That doesn’t happen in every class.”
While Mayes is committed to teaching students, he is constantly asked by nurse, physician and hospital administrator groups to present on current legislation, the implications of change and how health care institutions’ financial responsibilities may shift. With Congress’ inability to agree on changes to Obamacare, Trump’s promise to repeal and replace it, and open enrollment just months away (Nov. 1 to Dec. 15), there is great potential for change – or continuation – of a system that, while flawed, has offered care to some 22 million more Americans.
Mayes believes a hybrid system – like the Japanese, Australian and Canadian health care systems – may ultimately be America’s solution. He also notes the growing number of governors who are working closely and pragmatically with their representatives to shore up health care issues related to coverage and rising premiums.
Mayes cites the growing interest in his class as part of a larger trend of student interest in health policy work as a career, a non-clinical way to be part of health care change and progress.
“Across the board, there are a growing number of students who don’t necessarily want to become nurses or doctors, but who want to help strengthen health policy by working in the sector just because it’s the field of caregiving,” he said. “They come from all over and have begun to realize that health care is a part of everything; it’s not a separate silo, doesn’t exist in a vacuum by itself.
“I want to see more non-nursing students taking a health care class in the School of Nursing. That’s the best thing to come of all of this. The mix of people brings the class to another intellectual level, and we all end up swapping information and stories and learning from one another.”
The connectivity, he said, gives him hope for legislators tasked with Obamacare’s future.
“The public has been learning how difficult this is to resolve,” he added. “And even Republicans who fought the ACA tooth and nail at its introduction realize how difficult it is to change now that Americans have sampled what the ACA offers.”