Studying the Effects of Health Insurance Regulation on Workers and Employers

Article excerpt

Kosali Simon, an assistant professor of policy analysis and management, begins her courses in health care policy by drawing a circle in the center of the board. "What are we ultimately concerned about here?" she asks students in both the undergraduate course Economics of Health Policy and the graduate course Health Policy. She answers her own question by writing "the health of the population" in the circle.

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As the lecture proceeds, more circles appear; Simon fills them with phrases including "person's own actions," "genetic make-up," and more. The circle titled "medical care" has satellite circles marked with "hospital standards" and "doctor licensure." The topic "health insurance" also is given a circle of its own, with many smaller circles around it.

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While interested in the broad fields of health economics, labor economics, and public finance, Simon, who joined the Cornell faculty in 2001, currently is concentrating on the economics of health insurance policy.

"I use this graphic at the start of health care policy courses because I want students to remember that everything in health policy relates to the ultimate goal of creating a healthy population," she explains. "The chart also shows that it's possible to separate all the components that can influence people's health." For the rest of the semester Simon and her students systematically examine all of these interacting elements and the hierarchy of issues imbedded within them.

Within the subject of medical care, for example, one of the topics affecting the health of the American population that is most hotly debated--in politics as well as Simon's classroom--is the consequence of public policy on the price of prescription drugs. Examining what goes into the price of prescription drugs leads to a discussion of patents, an essential incentive for pharmaceutical companies to invest in research and drug development. Since the goal is to create the most number of new pharmaceuticals in the most affordable way, how long, she asks the class, should those patents extend? In that discussion she exposes an inherent conflict--a reasonably long patent is required as an effective incentive, but the longer the patent life, the higher the price of the drug.

In this way, within a single topic Simon shows students how complexities abound in the realm of public policy making. Any policies aimed solely at reducing the price of drugs can have grave consequences for the future, she points out. One example that she uses includes medications developed to treat HIV-positive individuals and those with active AIDS. If the government were to eliminate patents and allow the production of generic AIDS drugs, there would be a huge health benefit for people who cannot now afford the expensive medications, she explains. But the potential loss to future generations of Americans is huge if pharmaceutical companies stop creating new drugs.

Since AIDS occurs worldwide, Simon requires her students to consider the implications of international policy overriding patents for drugs that are sold abroad. This experience shows students how a debate about intellectual property rights has major consequences for the availability of AIDS drugs, she notes.

"I want students to realize that while there are tools provided by disciplines such as economics that allow a problem to be analyzed, that does not mean everyone comes to the same conclusion," says Simon. Nor does it mean that what analysts conclude actually will happen. For these reasons, she explains, rigorous research is imperative.

Examining the effects of health insurance regulations and institutions on labor market and health outcomes has compelled Simon since graduate school at the University of Maryland. As a native of Sri Lanka, she was struck by the uniqueness of the health insurance system in the United States, she explains. …