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Public Policy Week 3 Notes

by: Melissa Cairo

Public Policy Week 3 Notes 0100

Marketplace > Brown University > Public Health > 0100 > Public Policy Week 3 Notes
Melissa Cairo
Brown U

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notes covering ideology and more
Introduction to Public Policy
Robert Hackey
Class Notes
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This 10 page Class Notes was uploaded by Melissa Cairo on Monday February 15, 2016. The Class Notes belongs to 0100 at Brown University taught by Robert Hackey in Spring 2016. Since its upload, it has received 14 views. For similar materials see Introduction to Public Policy in Public Health at Brown University.


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Date Created: 02/15/16
Public Policy – Week 3 2/9/16 – Markets and Public Policy brooks free writing I disagree with him that free enterprise needs to be the core of American politics because that is assuming an equal playing field for all people and that is just widely known to be untrue. This is why I can’t wrap my head around his philosphoy because he is assuming a perfect society and is coming from a place of privledge as an educated and successful man. I do believe that if he were to better account for these things, his argument would be much stronger. I do agree that there is a lot of ways in which we are too helpful or to willing to give a handout in an effort to create a more equalized system. But with that, I think the more compelling argument would have been to discuss ways in which we could meld the two, instead of relying on no system or regulations to help prevent the clear discrimination and inequality that occurs in any free enterprise system especially in America. Free eneterprise leaves the door open for and incentivizes manipulation and abuse by those already in power so that they may retain that power. Thus, there needs to be some sort of government intervention, as an outside body. Brooks  Ignores discrimination and systemic barriers o Believes that hard work pays off – that is just an elitist view  Uses statistics and evidence but selectively o Not as compelling – supports his bias o Where does this information come from?  30% coalition ambition o claims they want equality of outcome? But really fighting equality of opportunity?  Money can’t buy you happiness o But absence of money can definitely make you unhappy?  Every argument is grounded in assumptions  Very aggressive, very biased, very opinion based  This is persuasive writing at work  Make authors prove their argument to you – try to find the holes in the argument and see how they close those holes – challenge them – force them to explain WHY????? Point of brooks  Have to engage in conversation – even if you disagree, that’s how you make progress, have to understand the other side so you can poke holes in their argument in order to make room for yours The Promise of Competitive Markets  Adam Smith – the wealth of nations o Unexpected benefit of competition o Individuals are the most motivated to benefit themselves o Invisible hand  Markets can promote the public interest and harness self interest  What do competitive markets require? 2 o Competition, multiple providers, demand, consumers o Need adequate information for Rational individual – can figure out the information that you want about anything  Price  Quality  Using these two things figure out: UTILITY – what are implicit rewards  Need enough information to make an informed decision o Need multiple sellers – need competition o What are the assumptions  Assume that markets are full disclosure – untrue o Ex. Rhode island charter schools  Increase competition and drive improvement o How do we decide what to produce?  NEED DEMAND  No demand? No production.  Ex. Pharmaceutical demand for many diseases but only profitable disease get pharma investment and resources How do we respond to changes in the marketplace?  Hirshman: three options in marketplace if a producer raises prices o Exit  People leave, the market disciplines those who deviate from the market price 3 o Voice  Pressure supplier to change behavior  Ex. Talk to the manager o Loyalty  Continue to purchase goods despite change in price  Relationships matter o Not all consumers will act the same*** Joseph Schumpeter  Appreciates the productivity of capitalism  Creative destruction – new things, constantly replacing the old with the new, the new thing that you did not know you needed you now need  Change and grow and evolve – what was in demand is no longer in demand  Here today, but tomorrow???  Ex. Myspace, napster, AOL were replaced, they were the icons Health Care as an imperfect market  Information issues o Insurers seek to avoid unhealthy patients – adverse selection  Insurers have different goals than patients – don’t want to spend money on sick people o Because of this… Consumers and patients may not fully disclose health status 4 o Insurers want young, healthy patients who will use few services – cream skimming/cherry picking o ASYMMETRY of information between doctors and patients o Uncertainty** about future medical needs and costs  This is where it gets confusing  Can choose different plans based on assumptions made about future health o Role of physicians as purchasers of care  CONSUMERS ARE NOT PATIENTS – that is the insurance companies o Patients want care – doctors have specialized knowledge and you trust them to be your primary purchaser  Different forms of competition o Price – traditional view o Market share – lower prices in order to get more people to sign up  Unsustainable because prices are too low  Prices can gradually rise once you get rid of competition  Make a local monopoly o Talent  Hospitals needs doctors because they refer patients to use hospital services  Assemble a good team that supports each other and attracts people to their services  New technology – mri, cat scans, pet  Surrogate for quality 5  Have to have the newest and latest thing to keep up with belief of quality – MEDICAL ARMS RACE**  Selecting colleges example  New buildings  New technology  If you don’t have this your school suffers in comparison o Status and prestige  Conspicuous consumption  Competition may not always drive down prices….**** Read fed 10, 51, timothy jost the house and the ACA, Jeffrey toobin “our broken constitution” 2/11/16 – Design of US political institutions 59 charlesfield – open house 4/5 reality of politics today  Living with a design that was created in the 1700s  Separation of powers o Ex. Climate change policy  Couldn’t pass legislation  Obama makes executive order  Courts stayed the executive orders 6  Constitutional design is the ultimate power o Protects long deliberation The shadow of the past  Madison – fed 10, 51 to the state of New York o New York was important: large, contested debate, in the middle – mission critical* a lynch pin o Madison  political propagandist/strategist  brilliant political theorist  embedded a theory of politics in his papers  what makes us tick?  Separate out his two different personas  A federalist – believes in strong national government – anti-jefferson  Political elite – privileged, wealthy, not representative  Madison laid the foundation for gridlock  Designed a system to not respond quickly to policy problems  Emphasize deliberation  Madison view of human nature  “Men are not angels” – fed 51  cannot be the judge of your own cause  self interest drives us  protect against self interest and manipulation easy to exploit, you are shaped by your experience 7  factions  self interested groups get together  get rid of liberty or make everyone have the same view – not actually a choice  causes of factions o economic circumstances shape politica conflicts  control the effect of factions****** o pure democracy doesn’t work – no safeguard against tyranny of the majority o republic – elect people to represent interest  better educated  less cooks in the kitchen  Afraid of big national government – get away from oppression o States are competing with each other o Problems with commerce – lack of unanimity among the states o Weak national government o Shay’s rebellion  What mortgage, what debt???  Have to raise up a private army to put out this rebellion  Philadelphia Convention o Supposed to amend the articles of confederation o The constitution is not perfect 8 o Very clear compromises made that were wrong o Create a new government o Strong enough to get things done, but not strong enough to oppress you  Diversity of Federalism Today o State legislature a lot of red, and a lot of divided states  Kindling a flame o State policies towards marriage equality  Success through the court  Very rapid change in support  Stalled momentum o Medicaid expansion  Separation of retained power o a lot of variation o way to get more done o states are laboratories of democracy  incremental change o physician-assisted suicide  regional differences within the overall nation Enlightened statesmen will not always be at the helm Fed 51 o separation of powers o jealous loyalties o checks and balances o veto, override 2/3 in both chambers 9 o designed to be at war with one another o Madison sees the legislature as the biggest threat to liberty because he thought it was supposed to be the most powerful branch o house o 2 year terms o represent the people o a lot of turnover o senate o equal representation of the states o electoral college o selection mechanism o recruitment mechanism 10


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