Nur 5701 Essay Two Assignment Instructions
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Dec 6, 2023
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Essay Two Assignment Instructions:
The Hobbesian concept of a social contract has been
manifested in the United States as liberal Democracy. That is, our chosen method of political
organization is an electoral democracy and our political system is rooted in the philosophy of
Classical Liberalism.
Inherent in Classical Liberalism (and in our political life) is the tension between the idea that
government's role should be largely limited to national defense and the protection of individual
freedoms or rights. While the other linked, yet at times contradictory, idea is that government
should have a role in promoting the larger social good: protecting the interests of most from the
few who might abuse them. Representations of these differing ideas can be found in the
writings of John Locke and Jeremy Bentham.
respectively
. One can find the tension
between these ideas at the heart of many of the controversies surrounding health policy.
In your second essay please discuss the following:
A. How might the tensions in Liberal Democracy, described above, come into play for
opponents or supporters of partial repeal of the Affordable Care Act health insurance reform?
[you will want to refer back to some of the material from Module 5. One potential focus could
be the 'individual mandate' (see p. 186 from prior readings in Mason et al.) or you may opt for
a different focus relevant to the ACA and potential repeals] in the Affordable Care Act health
insurance reform (see Mason p. 466).
Minimum Essential Coverage.
A minimum essential coverage provision (commonly referred to as the individual mandate) was
established, requiring most individuals to obtain health care coverage for themselves and their
dependents or face a shared responsibility payment (tax penalty) of either $95 or 1% of household
income, starting in 2014 and increasing thereafter. Coverage can be obtained through employer sponsored
health insurance, new state health exchanges, government programs
(Medicaid/Medicare), or grandfathered health plans, if the plan meets the ACA's minimum
essential coverage insurance standards. The Minimal Essential Benefits coverage “must include
items and services within at least the following 10 categories: ambulatory patient services;
emergency services; hospitalization; maternity and newborn care; mental health and substance use
disorder services, including behavioral health treatment; prescription drugs; rehabilitative and
habilitative services and devices; laboratory services; preventive and wellness services and chronic
disease management; and pediatric services, including oral and vision care” (
USCMS, 2014b
).
There is no individual mandate (the requirement to get coverage or pay a
fee). Instead, there is a 6 month waiting period to reenter the market if you
have a gap in
coverage for more than 63 days in the previous year (meaning
if you apply for coverage during open enrollment or during a special
enrollment you have to wait 6 months from the date of application to enroll
in coverage).
B. How might these tensions come into lay in a different public health issue such as obesity or
health impact of air pollution and carbon emission? (one paragraph)
Obesity policy offers an apt illustration of the numerous ways that public
health, together with its partners, can act on the root causes of ill health. By a
combination of zoning, public construction, taxation, incentives, regulation,
and health information, the state could encourage citizens to eat healthier
diets and maintain more active lifestyles. This could be accomplished by
changing the inner city, for example, to favor supermarkets over fast foods,
recreational facilities and green spaces over roads, mass transportation over
automobiles, and so forth. It could involve transformation of schools to ensure
healthier snacks and lunches, physical activity, and health education. Critics
complain that diet and lifestyle are personal choices outside the appropriate
realm of government. However, there is nothing inherently wrong with having
the state make healthier choices easier for people to make.
C. How is your political analysis of these issues (A and B) affected by your values a a nurse an
aspects of your own political philosophy?
See syllabus for essay grading criteria.
Submit your completed written assignment by Day 7, by 11:59 pm.. Assigned Readings: draw on
the following resources to support your essay - Mason et al., Ch 6 and 8, along with Assigned
Topical Readings under "Read and Watch Online." For detailed instructions on completing this
assignment, see the associated course page.
Justice is so central to the mission of public health that it has been described as the field’s core
value. This account of justice stresses the fair disbursement of common advantages and the
sharing of common burdens. It captures the twin moral impulses that animate public health: to
advance human well-being by improving health and to do so particularly by focusing on the
needs of the most disadvantaged.
this paper shows how public health based on social justice gives rise to
important policy imperatives such as improving the public health system,
reducing socioeconomic disparities, addressing health determinants, and
planning for health emergencies with an eye on the needs of the most
vulnerable.
the fair disbursement of common advantages and the sharing of common
burdens. It captures the twin moral impulses that animate public health: to
advance human well-being by improving health and to do so by focusing on
the needs of the most disadvantaged
two aspects of justice—health improvement for the population and fair
treatment of the disadvantaged—create a richer understanding of public
health.
A core insight of social justice is that there are multiple causal pathways to
numerous dimensions of disadvantage. These include poverty, substandard
housing, poor education, unhygienic and polluted environments, and social
disintegration
Inequalities beget other inequalities, and existing inequalities compound,
sustain, and reproduce a multitude of deprivations
American culture openly tolerates the expression and enjoyment of wealth
and privilege and is inclined to view health as a matter of personal
responsibility.
The exercise of the state’s coercive power has been highly contentious
throughout U.S. history. When public health officials act, they face troubling
conflicts between the collective benefits of population health on the one hand,
and personal and economic interests on the other.
Sanitary regulations similarly intrude on economic liberties such as freedom of
contract, pursuit of professional status, and use of personal property. Justice
demands that government take actions to safeguard the public’s health, but
that it do so with respect for individuals and sensitivity to the needs of the
underprivileged.
Fairness requires just distributions of burdens and benefits to all, but also
procedural due process for people subjected to compulsory interventions.
does do is insist that governmental action address the major causes of ill
health, particularly among the disadvantaged; that commitment has major
implications for political and social coordination.
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The justice perspective’s emphasis on the multicausal and interactive
determinants of health suggests that strategic opportunities for prevention and
amelioration of ill health arise at every level of governmental interaction. The
challenge of combating the threat of systematic disadvantage can be met only
with a systematic response among all levels of government.
A national commitment to capacity building is important because public needs
for health and well-being are universal and compelling. The federal
government should recognize these needs and invest in a strong public health
system. Certain problems demand national attention. A health threat, such as
epidemic disease or environmental pollution, might span many states,
regions, or the whole country. Further, the solution to problems such as those
related to foreign or interstate commerce could be beyond the jurisdiction of
individual states. Finally, states simply might lack the expertise or resources to
mount an effective response in a major public health emergency.
Armed with sufficient resources and tools, states and localities have an
obligation to fulfill core public health functions such as diagnosing and
investigating health threats, informing and educating the public, mobilizing
community partnerships, and enforcing state health laws. States and localities
are closer to the people and to the problems causing ill health. Delivering
public health services requires local knowledge and direct political
accountability.
Funding for prevention and population-based services is inordinately low, and
categorical funding for special programs such as bioterrorism and avian flu is
limited to a single issue and is time restricted.
To assure that actions can be taken to protect, promote, and provide for the
health of the public, there must be a substantial and stable commitment to the
public’s health at the federal, state, and local levels
(Gostin & Powers, 2006)
Reference:
Gostin, L. O., & Powers, M. (2006). What Does Social Justice Require For The Public’s Health? Public
Health Ethics And Policy Imperatives.
Health Affairs
,
25
(4), 1053–1060.
https://doi.org/10.1377/hlthaff.25.4.1053