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Health Systems 2019


Register here for Lobby Day for the NY Health Act (Single Payer for NY State)

First, some housekeeping....

Class starts on Tuesday March 6th and runs until Monday, April 2nd. We start promptly at 8:30 AM and meet in the third floor conference room at 3544 Jerome Avenue. Class will end at noon. On some Tuesdays (12-1) Dr. O'Connell will be give talks on Practice Management. Of note: the schedule is subject to change but we will keep you informed when changes are made. Here is the current schedule:

Week 1: History of the US Healthcare (How we got here)

Week 2: Special Populations and Alternatives

Week 3: Mental Health, Unions and Advocacy

Week 4: Single Payer and Reproductive Justice

Of note: the schedule is subject to change but we will keep you informed when changes are made.

There are some special things planned for this month which we will discuss on the first day of class.


Key Health Policy Articles (with one line summaries)

Time Magazine - BITTER PILL: WHY HIGH HEALTH CARE COSTS ARE KILLING US - Steve Brill - April 4, 2013

     Long award winning investigative piece on why prices set by "Charge Masters" are so high, esp for the uninsured

New Yorker - The Heroism of Incremental Care Jan 23 2017

      The Unrecognized Value and Cost Effectiveness of primary care) 

Atul Gawande - The Cost Conundrum - JUNE 2009 - The New Yorker

    Despite similar democgrahics as poor border counties McAllen spends twice El Paso. Obama famously had his entire staff read this article on the high costs in entrepeneurial areas.

Atul Gawande - (the Sequel) Health Care's Price Conundrum  - Dec 2015

     Private insurance data show great variation in the prices paid, largely related to monopoly pricing by hospitals

Atul Gawande - The Hot Spotters - JAN 2011

      In Camden NJ, family doc Jeffrey Brennan finds that a small number of very ill patients lead to a lot of health costs, and providring social services and attending to SDOH cuts costs.

THE CASE FOR REPARATIONS - Ta-Nehisi Coates - The Atlantic June 2014

          Redlining and federal housing policy dating from WW2 thru the 1970s and beyond leads to great racial wealth disparities in wealth.  We as a society should compensate those harmed by this federal policy.

Book Exerpt: The Heart of Power - David Blumenthal and James Marone President and Health Policy - last chapter 

        Summing up the experiences of 11 presidents up to GW Bush on health policy

Kaiser Family Foundation: Medicare, a Primer

Kaiser Family Foundation: Medicaid, a Primer

NY State DSRIP - an analysis from The Commonwealth Fund APRIL 2016

PNHP :Physicians Proposal for a National Health Program -JAMA 2003  - The latest version of the PNHP national proposal

The VA out peforms the Private Sector Nov 2015 American Prospect  

            TheVA is a punching bag for those who oppose publicservices, but the data is equal or superior to the rest of the health system, even with older, sicker, poorer patients.

The VA - Attacked even while performing as a Model Public System Nov 2015 American Prospect

History of the Health Systems Course

Health Systems is one of the three "core courses" of the Social Medicine Curriculum set up at the RPSM in the early 1980's.  For many years it was designed and taught by Dr. Hal Strelnick.  Beginning in 2011, Dan O'Connell and Matt Anderson became the course directors.  This is our eightth year teaching the course and every year we incorporate a good deal of new content.  One thing that has not changed is our commitment to listen carefully to you and to act on your feedback.  

In 2018, we have the continued attack on HC programs nationally and activism in the states for Single Payer, and important elections in coming years that may determine the next steps in US health policy. National issues will have major implications for the provision of healthcare in the US. While most of organized medicine has not opposed these changes, progressive doctors continue advocacy for some form of Single Payer Program (aka: Medicare for All). In a way we are privileged to have a front row seat at these developments and - potentially - to play some role in how things develop.

Goals of the Course

1. Understand the US health care system(s)

The alphabet soup of healthcare - ACA, CMO, PPO, PCMH, MACRA etc. - seems designed to confuse people. As it the dizzying way that programs urgently implemented today are dropped tomorrow. We will do our best to clarify the systems over the first two week. We hope by the end you will feel like experts.

2. Explore physician activism as a tool for social change

In the course of this month we will meet with a broad variety of health care professionals engaged in different forms of advocacy.   We will meetwith physicians who work within the government to promote public health. Others engage in political advocacy from the outside to change government policies (this is the focus of lobby day). Some involved in the course have joined unions (Dr. Roona Ray) or attempted to create alternative visions of health care. 

We will hear from physicians who have partnered with communities (Dr. Lanny Smith, Dr. Hal Strelnick) and others who have attempted to use the academic setting to promote change ( Dr. Marji Gold).  

Each of these forms of advocacy has its particular strengths and limitations.  We are offering you a chance to talk with those who are doing the work and learn from their experiences.

3. Explore Radical Critiques and Approaches

We will use the concept of the Medical Industrial Complex to critique main-stream debates about health care. We will reach back into history to explore the work of radical doctors and radical nurses. 

Lobby day for the New York Health Act is usually the last week of the course, but because of scheduling, this will be  Tuesday JUNE 5.  We still consider this a part of the course, though obviously some cannot make it as they may be on call/rotations. 

What we expect from you

  • We expect you to come to class and to do the readings. 
  • We want you to listen critically and ask questions.
  • Weekly Evaluations are very important for us.
  • Residents will be required to do two 5-10 minute presentation during the month.
Topics for presentations 


Register here for Lobby Day for the NY Health Act (Single Payer for NY State)
PNHP link on New York Health Act
90 min video on economics of NY healt Act
Full Text of New York Health Act
Village Voice story Jan 2017 on status of NY Health Act


We will be conducting evaluations at the end of each week and a summative evaluation on April 3, following the final session of the course.  This course is pass fail for all students.

Matt Anderson, MD

Dan O'Connell, MD


Family Medicine
Joanna Sharpless
Josh Yap
Sumathi Narayana
Mariya Masyukova
Samantha Stimmel
Lee Isaacsohn
Sara Fontanez
Sandya Kumar
Marissa Lapedis
Alexi Pappas

Internal Medicine
Sameen Farooq
Ashley Ceniceros
Richard Silvera
Louise Holaday

Shelby Davis
Kevin McKenna

Psychology Fellows
Yoo-Ri Lee
Alison Gurley