Discussion: NURS 6050 Population Health
Discussion: NURS 6050 Population Health

Discussion: NURS 6050 Population Health

Question

NURS6050/NRSE6050/NURS5050 Policy and Advocacy for Improving Population
Health

Week 3 Discussion Politics and the Patient Protection and Affordable Care Act

Regardless of political affiliation, individuals often grow concerned when considering
perceived competing interests of government and their impact on topics of
interest to them. The realm of healthcare is no different. Some people feel
that local, state, and federal policies and legislation can be either helped or
hindered by interests other than the benefit to society.

The suppliers of legislative benefits are legislators, and their primary goal is to be
re-elected. Thus, legislators need to maximize their chances for re-election,
which requires political support. Legislators are assumed to be rational and to
make cost-benefit calculations when faced with demands for legislation.
However, the legislator’s cost-benefit calculations are not the cost-benefits
to society of enacting particular legislation. Instead, the benefits are the
additional political support the legislator would receive from supporting
legislation and the lost political support they would incur as a result of
their action. When the benefit to legislators (positive political support) exceeds
their costs (negative political support) they will support legislation. (page
27)

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Discussion: NURS 6050 Population Health

These groups are often geographic populations such as nations or communities, but can also be other groups such as employees, ethnic groups, disabled persons, prisoners, or any other defined group. The health outcomes of such groups are of relevance to policy makers in both the public and private sectors.

Note that population health is not just the overall health of a population but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy—even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.

The right hand side of the figure indicates that there are many health determinants or factors, such as medical care systems, individual behavior, genetics, the social environment, and the physical environment. Each of these determinants has a biological impact on individual and population health outcomes.

Source: Feldstein, P.
(2006). The politics of health legislation: An economic perspective (3rd ed.).
Chicago, IL: Health Administration Press.

To Prepare:

Review the Resources
and reflect on efforts to repeal/replace the Affordable Care Act (ACA).

Consider who benefits the most when policy is developed and in the context of policy implementation.

Discussion: Politics and the Patient Protection and Affordable Care Act

Regardless of political affiliation, individuals often grow concerned when considering perceived competing interests of government and their impact on topics of interest to them. The realm of healthcare is no different. Some people feel that local, state, and federal policies and legislation can be either helped or hindered by interests other than the benefit to society.

Consider for example that the number one job of a legislator is to be reelected. Cost can be measured in votes as well as dollars. Thus, it is important to consider the legislator’s perspective on either promoting or not promoting a certain initiative in the political landscape.

To Prepare:

Review the Resources and reflect on efforts to repeal/replace the Affordable Care Act (ACA).
Consider who benefits the most when policy is developed and in the context of policy implementation.
By Day 3 of Week 3

Post an explanation for how you think the cost-benefit analysis in terms of legislators being reelected affected efforts to repeal/replace the ACA. Then, explain how analyses of the voters views may affect decisions by legislative leaders in recommending or positioning national policies (e.g., Congress’ decisions impacting Medicare or Medicaid). Remember, the number one job of a legislator is to be re-elected. Please check your discussion grading rubric to ensure your responses meet the criteria.

By Day 6 of Week 3

Respond to at least two of your colleagues* on two different days by expanding on their explanation and providing an example that supports their explanation or respectfully challenging their explanation and providing an example.

*Note: Throughout this program, your fellow students are referred to as colleagues.

RE: Discussion – Week 3
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                                                                                                               Module-2 Discussion Post

Healthcare is at the forefront of all presidential candidacy and agendas. It is no wonder that when an administration changes so does the legislations and bills that comes along in support of their constituents. When President Trump took office, he was elected on his platform of “Repeal, replace, repair or starve” the Affordable Care Act, (Milstead & Short 2019). This powerful stance allowed for much debate and anxiety about the fate of Medicaid and Medicare in the political arena. Private insurances, without the option to refuse people with preexisting conditions business model would fail (Milstead & Short 2019). These pressing issues placed legislators in a very difficult position, as with any political decision a Cost-Benefit Analysis (CBA) needs to occur before any big decision can be voted on. “A CBA is supposed to be a neutral decision tool that helps government decision makers focus resources to maximize the social returns of public investment…. In reality, CBA inevitably requires value judgments that are inherently subjective, rendering the analyses potentially manipulable for political ends” (Cole, 2012).  To make another dramatic change to our healthcare system once again, legislators need to carefully consider the outcomes of the bills that they supported.  The decision to support a bill that resends the progress made in the Affordable Care Act, could mean millions of people uninsured again, denied due to preexisting conditions. Supporting the ACA could potentially lead to a collapse in the private healthcare insurance business. A lot of variable to consider when a bill is presented to vote on by a legislator.

As mentioned before the subjective nature of a CBA could lead to manipulation of a legislator’s political agenda. If a legislator’s job is ultimately to get reelected and maintain their position, then they are ultimately working for constituents and special interest groups. If they were voted into office on a position that is not supported by evidence-based practice, then an angle or manipulation typically occurs to sell the views of their lobbyist. According to Taylor & et. al, politicians across the country are pushing for laws and regulations that restrict ethical standards of care and impose politics and ideology on evidence-based clinical care (2017). Depending on the motive behind a piece of legislation, sometimes the people who benefit the most are the legislators themselves. If the outcome is not considered for the population as a whole, with a true ethical CBA, then it can be a self-serving move. Understanding how legislation is passed, the importance on having a voice as a special interest group and lobbyist can help nurses and all healthcare disciplines drive the political system to advocate for better healthcare laws and patient outcomes.

References   

Milstead, J., & Short, N., (2019) Health Policy and Politics -A Nurse’s Guide. (6th ed.).

Jones & Bartlett Learning.

Cole, D. (2012) Law, Politics, and Cost-Benefit Analysis. Alabama Law Review Vol, 64:1:55 p55-89.

Eds-a-ebscohost-com.ezp.waldenlibrary.org

Fugate-Wood, N., Hagan, T., Johnson-Mallard, Olshansky, E., V., Safriet, B., & Taylor, D.,(2017)

Corrigendum to position statement: Political interference in sexual and reproductive health research and health professional education. Nursing Outlook 65 (2), p346-350.  http://dx.doi.org/10.1016/j.outlook.2017.05.003.

Submission and Grading Information
Grading Criteria

To access your rubric:

Week 3 Discussion Rubric

Post by Day 3 and Respond by Day 6 of Week 3

To participate in this Discussion:

Week 3 Discussion

Working with Legislators Program Transcript

FEMALE SPEAKER: The people who you are talking with in an elective office or their staffs are extremely bright. Having said that, do not assume that they know what you know. That’s what you bring to the table.

 

[MUSIC PLAYING]

 

These may be individuals that have never been in the hospital except for the day that they were carried out in their mother’s arms. They may not have had ongoing, extensive exposure to the challenges of the populations you’re serving. So you’re the voice to that. So bright people, but do not underestimate what you bring to that conversation.

 

FEMALE SPEAKER: I’ve always told students, if you ever go into a legislator’s office and heart conditions are your thing, don’t ever talk about all the CABGs that have been done. That’s a coronary artery bypass graft. They don’t know what a CABG is. They think a CABG is something that looks kind of like a lettuce, only it’s tougher.

 

We know not to use that kind of terminology with patients. We know not to use it with legislators, even though they may be lawyers and attorneys. They don’t understand medical terminology.

 

FEMALE SPEAKER: So it’s really important for people that you’re talking to know your background, to know that you’re a registered nurse, that you have a master’s degree, and your specialty is in a particular area. So you’re talking about the population you work for and maybe even where you work. That’s information that they need to know about you, because how they process the rest of what you tell them will be informed and influenced by their knowledge of your background.

 

So be sure that that’s the first thing you say to them. This is my name. This is what I am. And here’s where I’m from.

 

It’s really important to have your facts down, and that if there’s a question you’re asked and you don’t know the answer to it, to know that that’s OK, that you do the follow up coming back to them and letting them know, I don’t know the answer to that question. But I’ll be sure to get it for you. And then do it, and do it quickly.

 

We also should never stretch the truth, deviate from fact. If what we’re sharing is an opinion, we ought to let them know it’s an opinion. Now, I would say it’s an expert opinion, probably, on health care, because of our background. But be able to distinguish, my opinion is this, or based on my experience, this is what I see.

 

 

Additionally, it’s so important for us to be members of professional nursing organizations. It’s important, because it’s so challenging these days to stay abreast of the issues, challenges, problems, policies that are resonating at state and federal levels. So I stay in close touch through email communication that I get from the professional associations of which I’m a member. And when they ask me to do something, I act on it.

 

It doesn’t mean you have to be full-time in health policy to do this. It does mean that on occasion, spending five minutes to read up on an issue and then sending an email consistent with what my professional association is asking me to do, that might be at least as important as what you do for a patient or for family or for a community that day, because engaging there might actually be part of the trigger to get a policymaker to do something different than they may or may not have done otherwise.

 

FEMALE SPEAKER: It’s fine to disagree. But let’s work on what is going– that we can get done successfully together, though. And that’s been my whole thing with policy, collaboration across parties, working together to get things done.

 

When we have a disagreement, we disagree without hostility, but we certainly disagree clearly and reinforce our position with data, anecdote, things that will help communicate why we believe so fervently in the importance of a particular piece of legislation, a particular regulation, a particular program or policy.

 

So you can let them know that their position is not one that you agree with, that you have a different view. And you’d want to give them the information about why your view is different. But a tone of hostility is not helpful.

 

The other point I’d make is starting with common ground, trying to establish common ground. I know you care deeply about your constituents. I know you care deeply about mothers who are struggling as single parents and who frequently are living in environments that are impoverished, where it’s difficult for them to put food on the table and also pay for medications for their children. I know you care about that. And then taking that issue from there. So starting with common ground is important.

 

And absolutely thanking members of Congress and being there for them, or state legislators, when you think they’ve done the right thing. I can’t begin to tell you how much public thanks, and private thanks too, matter to people who are really working hard, from their vantage point, trying to do the right thing.

Communicating what the positions are of individuals, whether they’re for a position or they’re against it, it’s really important for us to communicate that, not just to the individual but more broadly to the public, in part because the public can help us leverage members of Congress and state legislators to do the right

 

thing too. So don’t keep it to yourself. Don’t even keep it within the nursing community. Push it out.

 

[MUSIC PLAYING]

Working with Legislators Additional Content Attribution

Trowell‐Harris, I. (n.d.). Various Photographs [Photograph]. Used with permission of Irene Trowell-Harris.

Wakefield, M. (n.d.). [Photograph]. Used with permission og Mary Wakefield WAL_NURS6050_NIH-SenatorDanielInouye

Official White House Photo by Pete Souza

GettyLicense_769805145

Akepong Srichaichana/EyeEm / EyeEm / Getty Images

Rubric Detail

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Content
Name: NURS_6050_Module02_Week03_Discussion_Rubric

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Excellent Good Fair Poor
Main Posting
Points Range: 45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 35 (35%) – 39 (39%)
Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by day 3.

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)
Does not post by day 3.
First Response
Points Range: 17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.

Points Range: 15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 13 (13%) – 14 (14%)
Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Second Response
Points Range: 16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.

Points Range: 14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 12 (12%) – 13 (13%)
Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
Name: NURS_6050_Module02_Week03_Discussion_Rubric

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