Repeal and replace. Medicaid expansion. Medicare-for-all. Essential benefits. Private versus government-funded insurance.
If ever there was a course done in real-time, UVA School of Nursing professor Rick Mayes’ graduate course Intro to the U.S. Healthcare System is it.
First developed and taught in fall 2014 as a primer for mostly nursing and medical students, Mayes—the Talbott Visiting Professor at the UVA School of Nursing through fall, 2017, a former White House advisor and health policy expert—today acknowledges that healthcare’s rapidly changing landscape makes fixed syllabi 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 the professional journals like Health Affairs and the Journal of the American Medical Association) provide the spice that flavor and drive classroom discussions.
And with the Affordable Care Act’s contentious passage, the U.S. Supreme Court’s declaration of its constitutionality in 2012, Medicaid expansion, Healthcare.gov’s rocky start, 22 million Americans gaining health insurance coverage, dramatic premium jumps, and the arrival of President Donald Trump, who calls Obamacare “a disaster,” there is much to cover.
Three years ago, Mayes had an even 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,” says Mayes. “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.”
Mayes notes that while his nursing and medical students often share poignant stories about patients affected by insurance costs or a lack of coverage, many students from Darden School of Business, the McIntire School of Commerce, Curry School of Education, Batten School of Public Policy, or political science who enroll have their own experiences and opinions to share.
“The main thing is that students are more interested and more emotionally invested in the topic,” says Mayes, “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 will examine European healthcare systems as well as some closer to home, like Geisinger, Kaiser Permanente and Intermountain. They’ll focus on the growing understanding of how primary care prevents catastrophic health events, distress and enormous medical costs down the line, examine employee wellness programs, and peer at some new venture capitalist programs with for-profit healthcare firms for primary care. Mayes’ students will also hear from healthcare stakeholders across the spectrum, from 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, says Mayes, 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.”
Students aren't the only ones Mayes teaches. He’s constantly being recruited by nurses’, physicians’ and hospital administrators’ groups to present on current legislation, implications of change, and how healthcare institutions’ financial responsibilities may shift. With Congress’s inability to agree on changes to Obamacare, President 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—“a muddle,” he says, like the Japanese, Australian and Canadian healthcare 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 healthcare 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.
“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 says. “They come from all over, and have begun to realize that healthcare 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 healthcare class in the School of Nursing,” says Mayes. “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 says, gives him hope for legislators tasked with Obamacare’s future.
“The public has been learning how difficult this is to resolve,” adds Mayes, “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.”