Increase Medicare premiums or increase taxes on Medicare benefits on a means-adjusted basis, which would reduce the level of financial assistance provided to higher income beneficiaries.

Continue to evolve Medicare and Medicaid payment policy away from fee-for-service and toward incentivizing providers to keep people healthy and out of expensive, intensive care settings like hospitals and nursing homes unless necessary.

Despite spending twice as much on healthcare per capita, utilization rates for many services in the United States is lower than other wealthy OECD countries. Prices, therefore, appear to be the main driver of the cost difference between the United States and other wealthy countries. In fact, prices in the United States tend to be higher regardless of utilization rates.

. However, despite higher healthcare spending, America’s health outcomes are not any better than those in other developed countries. The United States actually performs worse in some common health metrics like life expectancy, infant mortality, unmanaged diabetes, and safety during childbirth.

In 2024, the United States spent an estimated $14,885 per person on healthcare — the highest healthcare costs per capita across similar countries

Citizens of these countries are willing to make personal sacrifices (e.g., less convenience, longer wait times, fewer diagnostic and treatment options, more minimalistic guidelines for chronic disease prevention and management) so that their health care systems are more equitable and provide universal coverage.

In fact, the scope of services provided by family physicians has eroded in the era of Medicare-sponsored payment reforms.16 Medicare also does not support direct primary care models or other innovative ways for family physicians to deliver and be paid for their services, instead of being tied to the specialist-dominated Current Procedural Terminology (CPT) coding system.17

In 2016, the United Kingdom's National Health Service (NHS) refused to pay for lumacaftor/ivacaftor (Orkambi), an expensive cystic fibrosis drug.10 After two years of negotiations, a deal was reached allowing the manufacturer to supply the drug and its future versions. Although the price has not been disclosed, the NHS is thought to have agreed to about £10,000 to £20,000 ($12,000 to $25,000) per year per patient.11 In contrast, the same drug costs more than $258,000 per year per patient in the United States.12

Under Medicare for All, urban hospitals would close unless payments increased or regulatory burdens decreased, thereby reducing operating costs. The impact on rural hospitals would likely be mixed; those that already receive most of their income from public insurance plans and have high rates of uninsured patients could come out ahead. However, rural hospital sustainability would further depend on changes to existing alternative payment models, such as critical access definitions.

There is no dispute that administrative costs for Medicare (about 2% of overall costs1) are less than those for private health insurance, for which the Affordable Care Act sets the allowable overhead at 20% of premiums.2 However, expansion of Medicare or private insurance would not address the deeper problems in our health care system.

The necessary political compromises and private concessions to the doctors (reimbursements of their customary, reasonable, and prevailing fees), to the hospitals (cost plus reimbursement), and to the Republicans created a 3-part plan, including the Democratic proposal for comprehensive health insurance (“Part A”), the revised Republican program of government subsidized voluntary physician insurance (“Part B”), and Medicaid. Finally, in 1965, Johnson signed it into law as part of his Great Society Legislation, capping 20 years of congressional debate.

For may of the same reasons they failed before: interest group influence (code words for class), ideological differences, anti-communism, anti-socialism, fragmentation of public policy, the entrepreneurial character of American medicine, a tradition of American voluntarism, removing the middle class from the coalition of advocates for change through the alternative of Blue Cross private insurance plans, and the association of public programs with charity, dependence, personal failure and the almshouses of years gone by.

In 1917, the US entered WWI and anti-German fever rose. The government-commissioned articles denouncing “German socialist insurance” and opponents of health insurance assailed it as a “Prussian menace” inconsistent with American values. Other efforts during this time in California, namely the California Social Insurance Commission, recommended health insurance, proposed enabling legislation i n 1917, and then held a referendum. New York, Ohio, Pennsylvania, and Illinois also had some efforts aimed at health insurance. But in the Red Scare, immediately after the war, when the government attempted to root out the last vestiges of radicalism, opponents of compulsory health insurance associated it with Bolshevism and buried it in an avalanche of anti-Communist rhetoric.

In 1906, the American Association of Labor Legislation (AALL) finally led the campaign for health insurance. They were a typical progressive group whose mandate was not to abolish capitalism but rather to reform it. In 1912, they created a committee on social welfare which held its first national conference in 1913. Despite its broad mandate, the committee decided to concentrate on health insurance, drafting a model bill in 1915.

The campaign for some form of universal government-funded health care has stretched for nearly a century in the US On several occasions, advocates believed they were on the verge of success; yet each time they faced defeat

Value-based care can be thought of as appropriate and affordable care (tackling wastes), and integration of services and systems of care (i.e., hospital, primary, public health), including preventive care that considers the long-term health and economy of a nation [34,35]

Beyond individual and federal costs, other common arguments against universal healthcare include the potential for general system inefficiency, including lengthy wait-times for patients and a hampering of medical entrepreneurship and innovation

For example, Germany uses a multi-payer healthcare system in which subsidized health care is widely available for low-income citizens, yet private options—which provide the same quality and level of care as the subsidized option—are also available to higher income individuals. Thus, universal healthcare does not necessarily preclude the role of private providers within the healthcare system

significant upfront costs and logistical challenges.

This commentary offers discussion on the pros and cons of universal healthcare

3. Once you have your issue, consider your stance. What do you think about this issue? What is your initial opinion? This is your working thesis.

2. Once you have a Topic, narrow that down to an issue. An issue is anything that can be debated from multiple sides. For example, starting with the topic of Capitalism, and narrowing that down to the issue of homelessness in San Francisco.

1. What are some personal experiences you have that relate to larger social issues? I was a medical provider back home in Nepal. During rural rotation, I saw a pregnant woman walk up to 4 hours to reach a basic health check post and denied basic care because she did not have insurance and could not pay out of pocket. I was a medical provider back home in Nepal. During rural rotation, I saw a pregnant woman walk up to 4 hours to reach a basic health check post and denied basic care because she did not have insurance and could not pay out of pocket. 2. Why are these issues important to you? This experience is important to me, it shows how even the most basic healthcare is inaccessible to people in Nepal. Irony is that Nepal's constitution guarantees basic access to health care to everyone. This moment forced me to question how if a pregnement woman walking 4 hours in labour can be denied care , what would be the fate of others facing serious issues. This experience is important to me, it shows how even the most basic healthcare is inaccessible to people in Nepal. Irony is that Nepal's constitution guarantees basic access to health care to everyone. This moment forced me to question how if a pregnement woman walking 4 hours in labour can be denied care , what would be the fate of others facing serious issues. 3. Choose one of these issues to discuss: Why or how would your research of this issue represent an example of “intrinsic motivation” for you? Universal health care to basic medical care in Nepal: i would research this topic because that is one of the most basic need that a citizen would expect from their government. I want learn more on how my country is not able to provide basic acess to healthcare. Universal health care to basic medical care in Nepal: i would research this topic because that is one of the most basic need that a citizen would expect from their government. I want learn more on how my country is not able to provide basic acess to healthcare. Name: Kamal Shrestha

In other words, they learned to read using pictures (like parallel text sets from Chapter 1!) that showed bricklayers laying bricks, and pictured other situations that the students knew from their own lived experience and oppressive situations. Reading and writing became empowering because they gave these students a written voice for their struggles, and allowed them to engage in the “conversations” that directly affected their lives.

Kohn advocates for an education system that cultivates children’s authentic curiosity at a young age. By starting the inquiry process early in a child’s education, or in the First Year of college for that matter (which is considerably later, but important nonetheless), students come to see learning not as reading, memorizing, and providing the correct answer

Print and lay out your annotated bibliographies on a table in front of you; alternatively open all the documents on your home screen, and reread what you have written.Starting with one of your sources, use notecards or sticky notes to write out ONE idea or major claim from your summary. B

You’ve probably been warned not to cite Wikipedia as a source for your assignments, right? There are good reasons for that, and even the Wikipedia community acknowledges that Wikipedia is not a reliable source, especially for academic use. However, it can be a very helpful starting point, as long as you keep a few points in mind:

To search within a certain website or source, write site: sfchronicle.com before your search terms (e.g., within the SF Chronicle website); or use any other url. For example, you can use site:.gov to search only government websites.Try using “AND,”  or “OR” between two or more search terms. AND will limit your search. OR will expand it.

Before consulting various search engines or databases, you can prepare by brainstorming search terms you’ll try out to find sources of information and knowledge.

We are (most likely) all familiar with google, and we’re also probably used to considering whether we believe a source or not, how legit it is, and whether it is, to use the parlance of our times, “fake news.”

Curiosity, Engagement: Develop your personal interests, passions, and experiences related to larger social issues into open-ended “Inquiry Questions” to guide your entire research process. Connect your ideas to those of other authors.Critical Information Literacy: Learn strategies for finding and evaluating knowledgeable sources to investigate your Inquiry Question, and develop skills to evaluate the credibility of all sources of information in your lives. By continuing to view reading, research and writing as an ongoing conversation, build your own credibility by establishing your own ideas in relation to sources you evaluate. Openness: Continue to practice being open: open to new ways of asking questions, open to new ways of finding information and knowledge from sources, open to relating to new perspectives that you will find in those sources.

We also encourage you to find YouTube videos and other more visual ways of organizing any information you read for this class on your own, not in place of reading but in addition to it, to add to your understanding of the concepts and the ideas being shared.

Chunking and close reading are inter-related reading strategies that allow readers to “zero-in” on one or two passages that are especially difficult to understand. Often, as mentioned before, it is beneficial to annotate this difficult place as you read, ask your question in the margins, and continue on to see if the context of the rest of the article or chapter, or video, answers your questions.

Being an active reader in the above ways also varies depending on what discipline you are reading within. For example, the way you read and annotate in a Literature class will vastly differ from the way you read, annotate, and probably take additional notes when reading a Biology textbook. Additionally, some subjects may be more apt to multimodal reading, involving animation or supplemental Youtube videos provided by the professor, or that you find to help your comprehension.

We have just established that there are multiple ways of thinking, learning, and expressing ourselves. It is no surprise, then, that there are multiple ways of reading, and that reading and writing are connected. An important part of growing as a reader and writer is understanding who you are as a learner, but also learning from the models provided to you by readers and writers who came before you. The best way to increase your vocabulary, formality, or other skills, habits, and choices that professional writers make, for example, is by reading, and specifically reading in the discipline in which you wish to write.

What do you know about the topic, author, genre or any other aspect of the text BEFORE starting to read? What clues does the text give you to make predictions?W–What do you want to know? What questions do you have? Where does your natural curiosity take you?L–AFTER READING, using your annotations (see below), list what you learned. What were the most fascinating or interesting take-aways for you? Why do you think you connected with these particular ideas or claims of the author or text?+ –What do you still want to know? What questions were not answered when you read, and do you think you could find them if you re-read the text? What new questions were sparked during your reading process?

Active reading involves various practical steps. While we will outline these steps to help you be a practical, active reader, remember where we started: you are a diverse learner. As you read on, try out various strategies and figure out what works best for you as a learner. Some fundamental practices of active reading, like annotation, are universal but adaptable based on how you develop. For example, annotating on screen as opposed to taking notes by hand, or writing certain symbols in the margins that make sense to you

In this document authored by the National Council of Teachers of English (NCTE) and the Conference on College Composition and Communication (CCCC), they argue that English is not a fixed language, yet has still been used to uphold fixed standard for achievement tests where naturally those who have continually “failed” come out believing that “reading and writing is not for them.” Once students find out that various Englishes are legitimate and valid in the real world, even in the academic community and within scholarly discourse, their perspectives on English changes. Once students like you know that you are allowed to have your own voice as an academic writer—once you are able to develop a more flexible mindset about “English” through various reading and writing experiences included in this textbook—you will be better prepared to grow as readers and writers.

The next premise of this textbook is that learning must be challenging. We borrow from developmental psychologist Lev Vygotsky and his theory of the Zone of Proximal Development (ZPD). Image Source: https://psychology-spot.com/comfort-zone/ In our classrooms, we adapt the ZPD to the Zone of Appropriate Challenge and Growth. When teachers recite a pre-scripted curriculum that doesn’t assess the students’ prior knowledge and appropriate level of challenge, students end up in the center—“the Comfort Zone”—where they are not engaged, they are bored, and they become passively complacent about learning.

To counter this trend, particularly in Writing Studies but also across the educational spectrum, teachers are being forced to confront the reality of what Howard Gardner calls “multiple intelligences” in the classroom, expressed and practiced through what the New London Group of composition theorists calls “multiliteracies.” Building on Kohn’s assertion that students’ “purposes and interests” should inform the curriculum and classroom discussion, this textbook is also built on the premise that each reader has various skills, assets, and learning styles that may not have been rewarded or stimulated in various parts of your education.

Students are expected to do whatever they’re told, to accommodate themselves to a curriculum that was created by adults who never met them” (3). Sound familiar? We hope not, but unfortunately, it is all too familiar to most high school students and something we wish to address in our courses.

This is called constructivist learning, where the knowledge in the classroom is constructed from below (which requires that students are collaborating with teachers)—as opposed to knowledge or information delivered from the top (where teachers deliver a lecture).

The way we will frame the ensuing text about learning, reading, writing, research, and college life in general is through the metaphor and real experience of a journey. Like all trips, this book will have a beginning and an end, with a middle that will provide many insights and stories from our teaching that are hopefully memorable because they relate to your own experience. In fact, one premise of this book is that all meaningful reading and writing is personally motivated in some way: motivated by your connections, motivated by your passions and interests as students. And although your college journey will come to an end in four, five, or six years, we hope that the lessons, practices, and habits that you will learn and practice through this interactive textbook will transfer to many courses, and beyond to many life situations in your career and elsewhere.

Engagement in Active Learning: Introduce how this textbook and classroom activities will engage students in active learning as they read, to engage students with interactive experiences during the process of learning and reading.